Health Disparities
Association of cumulative adverse social determinants of health score with insufficient sleep duration among U.S. adults. Kelley M. Pascoe* Kelley Pascoe Yilda Macias Pandora L. Wander Alyson J. Littman
Introduction: Insufficient sleep duration is associated with individual adverse Social Determinants of Health (SDoH) and with poor health outcomes. However, the association with cumulative adverse SDoH is unclear.
Methods: Using 2022 Behavioral Risk Factor Surveillance System data from 35 U.S. states and two territories (n=236,406) we examined the association of self-reported insufficient sleep duration (<7 hours) with cumulative adverse SDoH scores among adults. We fit binomial logistic regression models using grouped-linear adjustment for SDoH scores and indicator variables for sex, age, and race/ethnicity to estimate unadjusted and adjusted weighted PR (PR and aPR) and 95% CI. We assessed interactions by sex and race/ethnicity.
Results: Participants were mostly non-Hispanic white (77%), employed (51%), coupled (57%), and had a college degree or higher (44%). Approximately 32% of participants reported insufficient sleep. For every unit increase in SDoH score the prevalence of insufficient sleep was 24% higher after adjusting for sex, age and race/ethnicity (aPR=1.24, 95%CI: 1.23-1.26). Race/ethnicity modified the association between SDoH score and insufficient sleep. The association between SDoH score and insufficient sleep was stronger among non-Hispanic Asians (aPR: 1.96, 95% CI: 1.70, 2.26), intermediate among Hispanic (aPR: 1.34, 95% CI: 1.01, 1.80), non-Hispanic whites (aPR: 1.32, 95% CI: 1.30, 1.33), and non-Hispanic other race groups (aPR: 1.30, 95% CI: 1.14, 1.49), and weaker among non-Hispanic Black (aPR: 1.16, 95% CI: 1.13, 1.20) and non-Hispanic American Indian/American Native (aPR: 1.02, 95% CI: 0.80, 1.28) groups, adjusting for age and sex. Associations did not differ by sex.
Conclusion: Higher adverse SDoH scores are positively associated with insufficient sleep duration. Future research should examine underlying mechanisms linking cumulative SDoH experiences and sleep health.
