Wetzel Sarah, Bilal Usama
Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
BMC Public Health. 2024 Dec 18;24(1):3410. doi: 10.1186/s12889-024-20977-w.
Sleep is a crucial determinant of physical and mental health outcomes, and insufficient sleep is highly prevalent among United States adults. Although some risk factors of poor sleep have been extensively studied, including substance use, age, health behaviors, and others, the associations between socioeconomic status (SES) and sleep remain inconclusive. There is limited evidence on SES and sleep duration among the US adult population. This study analyzed the relationships between three SES indicators (poverty, education, and food security), and sleep duration.
We used responses from the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Respondents younger than 25 years old were excluded. Sleep duration was classified using self-reported sleep time and stratified by work vs. non-workdays. SES was operationalized using three indicators: poverty-income ratio, educational attainment, and food security status. We imputed missing data for socioeconomic status and outcome variables using multiple imputation. Weighted Poisson regression models with robust standard errors were used to calculate the crude and adjusted prevalence ratios for insufficient sleep duration (< 7 h of self-reported sleep) on workdays and non-workdays separately by each of the three SES indicators.
We included a total of 8,457 individuals. In the adjusted model, participants with lower income, educational status, and food security had significantly higher prevalence of insufficient sleep duration on both workdays and non-workdays. For example, low-income individuals (poverty-income ratio < 1) had 1.22 (95% CI 1.04-1.44) and 2.08 (95% CI 1.61-2.67) higher prevalence of insufficient sleep as compared to high income individuals on workday and non-workdays, respectively. In general, we found larger differences by level of SES indicator for the non-workday than for the workday outcome. There were no major differences in gender-stratified analysis. We also found that lower SES was associated with higher prevalence of excessive sleep (≥ 9 h).
Socioeconomic status indicators are significantly associated with sleep duration in the US adult population. Lower SES correlates with increased prevalence of insufficient sleep duration, which has implications for the overall wellbeing of US adults with lower SES. Targeted interventions and further research are needed to reduce this disparity.
睡眠是身心健康结果的关键决定因素，睡眠不足在美国成年人中极为普遍。尽管一些睡眠不佳的风险因素已得到广泛研究，包括物质使用、年龄、健康行为等，但社会经济地位（SES）与睡眠之间的关联仍不明确。关于美国成年人群中SES与睡眠时间的证据有限。本研究分析了三个SES指标（贫困、教育和食品安全）与睡眠时间之间的关系。
我们使用了2017年3月至2020年国家健康与营养检查调查（NHANES）的回复。排除了25岁以下的受访者。睡眠时间根据自我报告的睡眠时间进行分类，并按工作日和非工作日进行分层。SES通过三个指标进行衡量：贫困收入比、教育程度和食品安全状况。我们使用多重插补法对社会经济地位和结果变量的缺失数据进行插补。使用具有稳健标准误的加权泊松回归模型，分别按三个SES指标计算工作日和非工作日睡眠不足（自我报告睡眠时间<7小时）的粗患病率和调整患病率。
我们共纳入了8457名个体。在调整模型中，收入较低、教育程度较低和食品安全状况较差的参与者在工作日和非工作日睡眠不足的患病率均显著较高。例如，低收入个体（贫困收入比<1）与高收入个体相比，在工作日和非工作日睡眠不足的患病率分别高出1.22（95%CI 1.04-1.44）和2.08（95%CI 1.61-2.67）。总体而言，我们发现非工作日SES指标水平的差异比工作日结果的差异更大。性别分层分析中没有重大差异。我们还发现，较低的SES与过度睡眠（≥9小时）的较高患病率相关。
社会经济地位指标与美国成年人群的睡眠时间显著相关。较低的SES与睡眠不足持续时间患病率的增加相关，这对SES较低的美国成年人的整体幸福感有影响。需要有针对性的干预措施和进一步的研究来减少这种差异。
