Fang Shona C, Subramanian S V, Piccolo Rebecca, Yang May, Yaggi H Klar, Bliwise Donald L, Araujo Andre B
New England Research Institutes, Inc, Watertown, Massachusetts, USA Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
J Epidemiol Community Health. 2015 Jan;69(1):63-9. doi: 10.1136/jech-2013-203256. Epub 2014 Sep 8.
Sleep plays an important role in health and varies by social determinants. Little is known, however, about geographic variations in sleep and the role of individual-level and neighbourhood-level factors.
We used a multilevel modelling approach to quantify neighbourhood variation in self-reported sleep duration (very short <5 h; short 5-6.9 h; normative 7-8.9 h; long ≥9 h) among 3591 participants of the Boston Area Community Health Survey. We determined whether geographic variations persisted with control for individual-level demographic, socioeconomic status (SES) and lifestyle factors. We then determined the role of neighbourhood SES (nSES) in geographic variations. Additional models considered individual health factors.
Between neighbourhood differences accounted for a substantial portion of total variability in sleep duration. Neighbourhood variation persisted with control for demographics, SES and lifestyle factors. These characteristics accounted for a portion (6-20%) of between-neighbourhood variance in very short, short and long sleep, while nSES accounted for the majority of the remaining between-neighbourhood variances. Low and medium nSES were associated with very short and short sleep (eg, very short sleep OR=2.08; 95% CI 1.38 to 3.14 for low vs high nSES), but not long sleep. Further inclusion of health factors did not appreciably increase the amount of between-neighbourhood variance explained nor did it alter associations.
Sleep duration varied by neighbourhood in a diverse urban setting in the northeastern USA. Individual-level demographics, SES and lifestyle factors explained some geographic variability, while nSES explained a substantial amount. Mechanisms associated with nSES should be examined in future studies to help understand and reduce geographic variations in sleep.
睡眠对健康起着重要作用，且因社会决定因素而异。然而，关于睡眠的地理差异以及个体层面和社区层面因素的作用，我们知之甚少。
我们采用多层次建模方法，对波士顿地区社区健康调查的3591名参与者自我报告的睡眠时间（极短<5小时；短5 - 6.9小时；正常7 - 8.9小时；长≥9小时）的社区差异进行量化。我们确定在控制个体层面的人口统计学、社会经济地位（SES）和生活方式因素后，地理差异是否仍然存在。然后我们确定社区SES（nSES）在地理差异中的作用。其他模型考虑了个体健康因素。
社区间差异占睡眠时间总变异性的很大一部分。在控制人口统计学、SES和生活方式因素后，社区差异仍然存在。这些特征占极短、短和长睡眠社区间方差的一部分（6 - 20%），而nSES占其余大部分社区间方差。低和中等nSES与极短和短睡眠相关（例如，极短睡眠OR = 2.08；低nSES与高nSES相比，95%CI为1.38至3.14），但与长睡眠无关。进一步纳入健康因素并没有明显增加所解释的社区间方差量，也没有改变关联。
在美国东北部一个多样化的城市环境中，睡眠时间因社区而异。个体层面的人口统计学、SES和生活方式因素解释了一些地理变异性，而nSES解释了很大一部分。未来的研究应探讨与nSES相关的机制，以帮助理解和减少睡眠的地理差异。
