"Sleep disparity" in the population: poor sleep quality is strongly associated with poverty and ethnicity

Abstract

BackgroundLittle is known about the social determinants of sleep attainment. This study examines the relationship of race/ethnicity, socio-economic status (SES) and other factors upon sleep quality.MethodsA cross-sectional survey of 9,714 randomly selected subjects was used to explore sleep quality obtained by self-report, in relation to socioeconomic factors including poverty, employment status, and education level. The primary outcome was poor sleep quality. Data were collected by the Philadelphia Health Management Corporation.ResultsSignificant differences were observed in the outcome for race/ethnicity (African-American and Latino versus White: unadjusted OR = 1.59, 95% CI 1.24-2.05 and OR = 1.65, 95% CI 1.37-1.98, respectively) and income (below poverty threshold, unadjusted OR = 2.84, 95%CI 2.41-3.35). In multivariable modeling, health indicators significantly influenced sleep quality most prominently in poor individuals. After adjusting for socioeconomic factors (education, employment) and health indicators, the association of income and poor sleep quality diminished, but still persisted in poor Whites while it was no longer significant in poor African-Americans (adjusted OR = 1.95, 95% CI 1.47-2.58 versus OR = 1.16, 95% CI 0.87-1.54, respectively). Post-college education (adjusted OR = 0.47, 95% CI 0.31-0.71) protected against poor sleep.ConclusionsA "sleep disparity" exists in the study population: poor sleep quality is strongly associated with poverty and race. Factors such as employment, education and health status, amongst others, significantly mediated this effect only in poor subjects, suggesting a differential vulnerability to these factors in poor relative to non-poor individuals in the context of sleep quality. Consideration of this could help optimize targeted interventions in certain groups and subsequently reduce the adverse societal effects of poor sleep.

Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study

“…Similar to lifestyle factors, sociodemographic factors (ie, racial background) have a significant effect on sleep quality on young males, but not females. Our results uphold previous findings of poor sleep in the minority population on sleep problems in young adults, 29 though evidence from longitudinal studies is needed to explore the differential effect seen in our study. We could not find a role for marital status in sleep quality, but it should be considered that the role of partnership support is mostly explored for older subjects.…”

How Socioeconomic Disadvantages Get Under the Skin and into the Brain to Influence Health Development Across the Lifespan

“…Adults with low income or education levels had significantly shorter sleep duration (Whinnery et al 2013) and poorer sleep quality and higher levels of daytime sleepiness compared to adults with mid-to high income or education levels (Jarrin et al 2013). The association between poverty and sleep quality was stronger in white adults than in African American adults (Patel et al 2010). In children and adolescents, both low subjective social standing ratings and low objective SED indicators including family income and parental education were significantly associated with shorter sleep duration and poorer sleep quality (Jarrin et al 2014).…”

Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences

“…A number of studies have indicated that sleep health disparities exist and that adults, 19 children, and adolescents [20][21][22] from families with low income or of racial or ethnic minorities may be at even greater risk of poor-quality and insufficient sleep. For example, in a recent study of middle school students, appropriate timing and consistency of both weeknight and weekend sleep schedules were inversely correlated with low socioeconomic status and specific household/neighborhood variables (eg, overcrowding, noise levels, safety concerns).…”