Geographic variations in sleep duration: a multilevel analysis from the Boston Area Community Health (BACH) Survey

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Regional contextual influences on short sleep duration: a 50 universities population-based multilevel study in China

“…At the individual level, Stamatakis et al [28], for example, showed that the (age-adjusted) odds of short sleep were greatest for the lowest household income quintile (OR = 1.62, 95% CI: 1.34, 1.94) and for those with less than a high school education (OR = 1.51, 95% CI: 1.30, 1.75). Furthermore, our finding that regional affluence was related to SSD is consistent with the one US multilevel study which showed that neighbourhood socioeconomic status was significantly related to sleep duration [11]. …”

“…Where such factors have been included they have mainly related to the home sleep environment, to school schedule variables, or to the impacts of the work environment [10]. More recently, however, there has been a growing interest in the effect of wider contextual factors on SSD, particularly the significance of neighborhood-level variables, such as disorder, safety, social fragmentation, and general environmental conditions on the duration and quality of sleep [11–14]. …”

Sleep duration associated with body mass index among Chinese adults

“…However, further studies taking these potential confounders into account are necessary. Third, residual confounding, for example, diet [36], geography, and environmental factors [37][38][39], might also partly affect the results.…”

Race and sex differences in ambulatory blood pressure measures among HIV+ adults

“…High stress, discrimination, residence in neighborhoods with higher levels of noise and crime, and lack of social support are frequently reported to be more common in African Americans than whites and are associated with non-dipping BP. 6, 15, 18–21 Worse sleep quality and sleep-disordered breathing in African Americans are additional mechanisms that may lead to racial differences in ABPM measures. 6, 22, 23 A narrative review reported that African Americans compared to whites have shorter sleep duration, lower sleep efficiency, a smaller amount of restful slow-wave sleep, a greater prevalence of insomnia and sleep-disordered breathing, and more severe sleep-disordered breathing.…”