Race-ethnic minoritized veterans diagnosed with sleep apnea, insomnia, and COMISA at the Veterans Health Administration have lower all-cause mortality than Non-Hispanic White veterans.

OBJECTIVE

Few data exist exploring the relationship between sleep apnea (SA), insomnia, comorbid insomnia and sleep apnea (COMISA) and mortality among race-ethnic minoritized (REM) US veterans. This study compares all-cause mortality among Veterans Health Administration (VHA) patients diagnosed with these sleep disorders by race-ethnicity.

METHODS

The study included veterans with confirmed diagnoses and prescribed treatment for insomnia and/or SA, within the VHA, from 1999 to 2023. Using self-reported data, eight race-ethnicity groups were generated (i.e., Non-Hispanic White [NH-W], Non-Hispanic Black [NH-B], Hispanic White [H-W], Hispanic Black [H-B], Non-Hispanic Asian [NH-A], Non-Hispanic American Indian/Alaska Native [NH-AIAN], Non-Hispanic Native Hawaiian/Pacific Islander [NH-NHPI]). Sleep diagnoses required International Classification of Diseases documentation. Additionally, insomnia was defined in those prescribed sleep medication or CBT-I while SA was defined in those prescribed positive airway pressure (PAP). All-cause mortality was extracted from national databases. For each sleep disorder, multivariable logistic regression determined the association between race-ethnicity and all-cause mortality, using NH-W as reference. Models were adjusted for demographics, comorbidities, medications, exposure time, and neighborhood socioeconomics.

RESULTS

This cohort consisted of 1,544,541 veterans (70% NH-W, 20% NH-B, 6.0% H-W, 1.2% NH-A, and 0.9% NH-AIAN). In adjusted analyses, compared to NH-Ws, REM veterans had lower mortality in SA (NH-A OR 0.30 [95% CI 0.27-0.33]; NH-NHPI OR 0.79 [95% CI 0.74-0.85], insomnia (NH-A OR 0.34 [95% CI 0.31-0.37]; NH-NHPI OR 0.84 [95% CI 0.74-0.86], and COMISA (NH-A OR 0.28 [95% CI 0.23-0.35]; NH-AIAN OR 0.71 [95% CI 0.61-0.83].

CONCLUSION

These data suggest that REM veterans using VHA sleep care have lower sleep disorder-related all-cause mortality than NH-White veterans, suggesting attenuated racial-ethnic mortality disparities within this equal-access healthcare setting.