Financial Hardship and Sleep Quality Among Black American Women With and Without Systemic Lupus Erythematosus

Abstract

Objective To compare dimensions of financial hardship and self-reported sleep quality among Black women with vs. without Systemic Lupus Erythematosus (SLE). Methods Participants were 402 Black women (50% with validated diagnosis of SLE) living in Georgia between 2017 and 2020. Black women with SLE were recruited from a population-based cohort established in Atlanta, and Black women without SLE were recruited to be of comparable age and from the same geographic areas as SLE women. Financial hardship was measured using three different scales: financial adjustments, financial setbacks, and financial strain. Sleep was assessed continuously using the Pittsburgh Sleep Quality Index (PSQI) scale. Each dimension of financial hardship was analyzed separately in SLE-stratified multivariable linear regression models and adjusted by sociodemographic and health status factors. Results Dimensions of financial hardship were similarly distributed across the two groups. Sleep quality was worse in Black women with, versus without, SLE (p < .001). Among Black women with SLE, financial adjustment was positively associated with a 0.40 unit increase in poor sleep quality (95% CI: 0.12, 0.67, p = 0.005). When accounting for cognitive depressive symptoms, financial setbacks and strain were somewhat attenuated for Black women with SLE. Overall, no associations between financial hardships and sleep quality were observed for the women without SLE. Conclusions Black women with SLE who experience financial hardships may be more at risk for poor sleep quality than Black women without SLE. Economic interventions targeting this population may help improve their overall health and quality of life.

Exploring the Interplay Between Stress, Sleep, and Health: A Special Issue Commemorating the Contributions of Dr. Martica Hall

“…Several articles also highlight the dynamic nature of sleep during critical periods across the life span (9) and multidimensional conceptualizations of sleep health (10), ideas and methodologies championed by Tica. We are also quite certain that Tica would have applauded the focus on social determinants of sleep and sleep health disparities (11–14) and the links between sleep and heart rate variability (15,16). Collectively, these articles fill in critical pieces of the theoretical framework pioneered by Tica, beginning with her dissertation work and developed throughout her illustrious career.…”