Health Disparities
Racial and ethnic disparities in sleep health – evidence from the United States (US) Behavioral Risk Factor Surveillance System (BRFSS), 2020 Wendy W. Dlamini* Rebecca J. Howett Wendy W. Dlamini Rashmi Maharjan Alyson J. Littman Amanda I. Phipps
Background: Inadequate sleep is associated with several poor health outcomes. It is unknown whether there are disparities in sleep by racial or ethnic group. We evaluated the association between race and ethnicity and inadequate sleep.
Methods: We conducted a secondary analysis of cross-sectional data from 388,639 US adults (aged ≥18 years) from the 2020 BRFSS. The exposure was self-reported race and ethnicity, aggregated into 8 groups: 7 race groups of non-Hispanic ethnicity (American Indian or Alaskan Native, Asian, Black, Multiracial, Native Hawaiian or Other Pacific Islander, White, Race Not Listed), and 1 Hispanic ethnicity group of any race. The analytic outcome was self-reported daily sleep duration (inadequate <7 hours, adequate ≥7 hours). We calculated weighted descriptive statistics and estimated weighted adjusted-prevalence ratios (aPRs) using log-quasibinomial regression. Sex and age were specified a priori as adjustment variables. Further, we explored effect modification by rural or urban residency.
Results: The overall prevalence of inadequate sleep was 32.7%. Compared to White participants (prevalence 30.6%), the prevalence of inadequate sleep was significantly greater among most non-White participant groups, with the exception of those who identified as Asian (30.5%, aPR=0.95, 95% CI: 0.88, 1.02) or Hispanic (32.3%, aPR=1.01, 95% CI: 0.97, 1.05). Inadequate sleep was most prevalent among those who identified as Black (43.6%, aPR=1.39, 95% CI: 1.35, 1.43) or Native Hawaiian or Other Pacific Islander (47.0%, aPR=1.47, 95% CI: 1.32, 1.64). There was no meaningful difference in associations when stratified by rural or urban residency.
Conclusion: US residents from most minority racial and ethnic groups have a higher prevalence of inadequate sleep compared with White non-Hispanic residents. Interventions are warranted to address structural factors that increase racial and ethnic minorities’ susceptibility to inadequate sleep.