Cultural Values in the ESADA Database

Abstract

Aims: Significant relationships between cultural dimensions, health behaviours, and policies exist across countries. We hypothesized that cultural differences contribute to the unexplained variance seen in multi-centre disease studies.

Method: We applied the Inglehart-Welzel model, waves 5 and 6 (2007-2014), to 14117 participants in the ESADA database diagnosed with OSAHS (AHI) ≥5 or A+H/time in bed ≥25 plus ESS ≥11/24). The cultural groups were: 1) Catholic Europe (Belgium, Croatia, Czech Republic, France, Greece, Italy, Portugal, Slovakia, Spain), 2) Protestant Europe (Finland, Germany, Norway, Sweden), 3) English speaking (Ireland, Scotland), 4) Baltic (Latvia, Lithuania), 5) Polish (Poland) and 6) Islamic (Turkey) Standard statistical analysis was performed with significance taken at p<0.0083.

Results: Differences were found across all six groups in age, anthropometric variables, cardiometabolic parameters, diagnostic and treatment strategies (all, p<0.001); the differences remained when males and females were examined separately (all, p<0.001). Multivariate logistic regression controlling for age, sex, lifestyle factors, ESS, OSA severity and anthropometric variables showed that cultural grouping predicted significant differences in the prevalence of cardiovascular disease (odds ratio (OR)=1.05, p=0.001), metabolic disease (OR=0.94, p<0.001), pulmonary disease (OR=0.89, p<0.001), psychiatric disease (OR=0.87, p<0.001), OSAHS phenotype (OR=0.85, p<0.001) and treatment (OR=1.44, p<0.001).

Conclusion: Cultural values account for significant heterogeneity in OSAHS presentation despite equivalent diagnostic parameters across countries and should be accounted for in all large multi-country databases.

ON BEHALF OF THE ESADA COLLABORATION