Chessa Ambra, Schrempft Stephanie, Richard Viviane, Baysson Hélène, Pullen Nick, Zaballa María-Eugenia, Lorthe Elsa, Nehme Mayssam, Guessous Idris, Stringhini Silvia
Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
Sleep Health. 2025 Apr;11(2):222-229. doi: 10.1016/j.sleh.2024.12.006. Epub 2025 Jan 22.
Social inequalities in sleep have been reported, but there is less research on the mechanisms underlying this association. This study investigates the relationship between financial hardship and sleep within the general adult population, focusing on the mediating effects of psychosocial and lifestyle-related factors.
We used data from the Specchio cohort, a population-based study in Geneva, Switzerland, initiated in December 2020. Perceived financial hardship and sleep outcomes (insomnia, sleep quality, and sleep duration) were assessed by questionnaire in 2020 to 2021. Counterfactual mediation analysis was conducted to examine the extent to which perceived financial hardship impacts sleep through psychosocial (psychological distress and loneliness) and lifestyle-related (weight, smoking, and physical inactivity) pathways. Models were adjusted for age, sex, education, living alone, and chronic disease.
Among 4388 participants, those experiencing financial hardship had a greater risk of insomnia (odds ratio: 2.11; 95% confidence interval: 1.70-2.61), poor sleep quality (odds ratio: 1.69; 95%confidence interval: 1.41-2.02), and not meeting sleep duration guidelines (odds ratio: 1.40; 95% confidence interval: 1.18-1.66) compared to those without financial difficulties. Psychosocial factors explained 40% of the relationship of financial hardship with insomnia, 35% of the relationship with poor sleep quality, and 10% of the association with suboptimal sleep duration. The contribution of lifestyle-related factors was 8%, 12%, and 17%, respectively.
Perceived financial hardship is a significant predictor of poor sleep, and this association is mediated by psychosocial and, to a lesser extent, lifestyle-related factors. These findings highlight the need for integrative approaches addressing social inequalities in sleep.
已有研究报道了睡眠方面的社会不平等现象，但对于这种关联背后的机制研究较少。本研究调查了普通成年人群中经济困难与睡眠之间的关系，重点关注心理社会和生活方式相关因素的中介作用。
我们使用了Specchio队列研究的数据，该研究于2020年12月在瑞士日内瓦发起，是一项基于人群的研究。2020年至2021年通过问卷调查评估了感知到的经济困难和睡眠结果（失眠、睡眠质量和睡眠时间）。进行了反事实中介分析，以检验感知到的经济困难通过心理社会（心理困扰和孤独感）和生活方式相关（体重、吸烟和缺乏身体活动）途径对睡眠产生影响的程度。模型对年龄、性别、教育程度、独居情况和慢性病进行了调整。
在4388名参与者中，与没有经济困难的人相比，经历经济困难的人患失眠的风险更高（优势比：2.11；95%置信区间：1.70 - 2.61）、睡眠质量差（优势比：1.69；95%置信区间：1.41 - 2.02）以及未达到睡眠时间指南的比例更高（优势比：1.40；95%置信区间：1.18 - 1.66）。心理社会因素解释了经济困难与失眠关系的40%、与睡眠质量差关系的35%以及与睡眠时间不足关联的10%。生活方式相关因素的贡献分别为8%、12%和17%。
感知到的经济困难是睡眠不佳的重要预测因素，这种关联由心理社会因素介导，在较小程度上也由生活方式相关因素介导。这些发现凸显了采用综合方法解决睡眠方面社会不平等问题的必要性。
