Department of Health, Society, and Behavior, Program in Public Health, University of California Irvine, 653 E Peltason Dr, Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA 92697-3957 (
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.
Prev Chronic Dis. 2023 Jan 26;20:E04. doi: 10.5888/pcd20.220241.
Disturbed sleep may be a factor that links stress with poor health, especially among groups experiencing high levels of stress caused by racial and ethnic minority and nativity status. The objective of this study was to describe the potential mediating role of sleep disturbance in the associations between various types of stress and self-rated health among Chinese and Korean Americans.
Our cross-sectional study consisted of 400 Chinese and Korean immigrants aged 50 to 75 years recruited from August 2018 through June 2020 from physicians' clinics in the Baltimore-Washington, DC, metropolitan area. We used the Patient Reported Outcomes Measurement Information System (PROMIS) short-form questionnaire to measure sleep disturbance. Linear regression analyses examined associations between 3 types of stress (acculturative stress, perceived stress, and distress) and self-rated health, accounting for demographic, socioeconomic, and health insurance factors. The Karlson-Holm-Breen method was used to estimate the total and direct effects of stresses on self-rated health and the indirect effects of stresses on health through sleep disturbance.
Greater acculturative stress (β = 0.08; 95% CI, 0.01-0.14), perceived stress (β = 0.05; 95% CI, 0.03-0.08), and distress (β = 0.09; 95% CI, 0.05-0.13) were all associated with poorer self-rated health. Sleep disturbance was a partial mediator, with sleep disturbance accounting for 21.7%, 14.9%, and 18.7% of the associations between acculturative stress, perceived stress, and distress and self-rated health, respectively.
Because sleep disturbance partially mediates the associations between stress and poor self-rated health, future interventions and research may consider mitigating sleep disturbances and stress among racial and ethnic minority populations to address health disparities.
睡眠障碍可能是将压力与健康状况不佳联系起来的一个因素，尤其是在那些因种族和民族少数群体以及出生国地位而承受高水平压力的人群中。本研究的目的是描述睡眠障碍在各种类型的压力与华裔和韩裔美国人的自我报告健康之间的关联中的潜在中介作用。
我们的横断面研究包括 400 名年龄在 50 至 75 岁之间的华裔和韩裔移民，他们于 2018 年 8 月至 2020 年 6 月从巴尔的摩-华盛顿特区大都市区的医生诊所招募。我们使用患者报告的结果测量信息系统（PROMIS）短表问卷来测量睡眠障碍。线性回归分析检查了 3 种压力（文化适应压力、感知压力和困扰）与自我报告健康之间的关联，考虑了人口统计学、社会经济和医疗保险因素。卡尔森-霍尔姆-布林方法用于估计压力对自我报告健康的总效应和直接效应，以及压力通过睡眠障碍对健康的间接效应。
更大的文化适应压力（β=0.08；95%置信区间，0.01-0.14）、感知压力（β=0.05；95%置信区间，0.03-0.08）和困扰（β=0.09；95%置信区间，0.05-0.13）均与自我报告的健康状况较差相关。睡眠障碍是部分中介因素，睡眠障碍分别解释了文化适应压力、感知压力和困扰与自我报告健康之间关联的 21.7%、14.9%和 18.7%。
由于睡眠障碍部分介导了压力与自我报告的健康状况不佳之间的关联，未来的干预措施和研究可能需要考虑减轻种族和少数民族人群的睡眠障碍和压力，以解决健康差距问题。
