School of Psychology & Public Health, La Trobe University, Bendigo, Vic., Australia; and Institute for Breathing and Sleep, Austin Health, Melbourne, Vic., Australia
Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia
Rural Remote Health. 2023 Sep;23(3):7704. doi: 10.22605/RRH7704. Epub 2023 Sep 13.
Geographical location is increasingly recognised as a contributor to health inequity, with barriers including travel distances and a shortage of healthcare services. Individuals living in rural areas are known to have increased illness and comorbidities. Obstructive sleep apnoea (OSA) is one such illness. OSA is a condition where a person repeatedly pauses breathing while asleep due to their airways becoming wholly or partially blocked, and it is associated with various chronic diseases. Exploration into the effects of these barriers on OSA is limited. This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural compared to metropolitan areas.
This was a cross-sectional, secondary analysis of the Australian Ten to Men dataset. The present study looked at men aged over 18 years diagnosed with OSA in their lifetime from wave 2 (n=10 513) and wave 3 (n=7262) of the dataset. Wave 2 data were collected between November 2015 and May 2016, and wave 3 between July 2020 and February 2021.
In wave 2, a higher proportion of rural men were diagnosed with OSA than metropolitan men (OR, 1.47, 95%CI 1.22-1.78, p<0.001), but not regional men. In addition, a significantly higher proportion of men in rural areas were at risk for OSA than metropolitan men (37.7% v 32.6%, p<0.0001). However, men living rurally were older, had higher BMI and lower socioeconomic status. Location was no longer a significant predictor of OSA after controlling for age, BMI and socioeconomic status. In wave 3, rate of diagnosis of OSA during the lifetime was no longer significantly associated with location (p=0.057) or being diagnosed with OSA in the previous 12 months (p=0.062).
This study highlights the need to ensure adequate services in rural areas, given the higher proportion of men diagnosed with, or at risk of, OSA in rural areas. OSA is also associated with an increase risk of comorbidities such as heart disease, hypertension and diabetes, which are diseases also seen more prevalently in rural men. Rethinking the distribution of healthcare services will go some way to addressing this problem.
地理位置越来越被认为是健康不平等的一个促成因素，其障碍包括旅行距离和医疗服务短缺。人们知道，生活在农村地区的人更容易患病和出现合并症。阻塞性睡眠呼吸暂停（OSA）就是这样一种疾病。OSA 是一种由于气道完全或部分阻塞，导致人在睡眠中反复暂停呼吸的疾病，它与各种慢性疾病有关。对这些障碍对 OSA 的影响的探索是有限的。本研究探讨了与城市地区相比，农村地区男性中确诊和未确诊 OSA 的比例。
这是对澳大利亚 10 到男性数据集的横断面、二次分析。本研究观察了在数据集的第 2 波（n=10513）和第 3 波（n=7262）中一生中被诊断为 OSA 的年龄在 18 岁以上的男性。第 2 波数据收集于 2015 年 11 月至 2016 年 5 月之间，第 3 波数据收集于 2020 年 7 月至 2021 年 2 月之间。
在第 2 波中，农村男性被诊断为 OSA 的比例高于城市男性（比值比，1.47；95%置信区间，1.22-1.78；p<0.001），但与地区男性没有差异。此外，农村地区男性患 OSA 的风险显著高于城市男性（37.7%比 32.6%；p<0.0001）。然而，农村地区的男性年龄较大，BMI 较高，社会经济地位较低。在控制年龄、BMI 和社会经济地位后，位置不再是 OSA 的显著预测因素。在第 3 波中，一生中诊断为 OSA 的比例与位置（p=0.057）或在过去 12 个月中被诊断为 OSA（p=0.062）不再显著相关。
本研究强调了在农村地区提供足够服务的必要性，因为农村地区男性被诊断为 OSA 或有患病风险的比例较高。OSA 还与心脏病、高血压和糖尿病等合并症的风险增加有关，而这些疾病在农村男性中更为普遍。重新思考医疗保健服务的分布将在一定程度上解决这个问题。
