Sleepless in COVID-19: racial disparities during the pandemic as a consequence of structural inequity

Abstract

Study Objectives Insomnia has been on the rise during the 2019 coronavirus disease (COVID-19) pandemic, which may disproportionately affect racial minorities. This study characterized racial disparities in insomnia during the pandemic and evaluated mechanisms for such disparities. Methods Participants included 196 adults (48 Black) from a 2016–2017 clinical trial of insomnia treatment who were reevaluated in April 2020. Race was evaluated as a predictor of change in insomnia, impact of COVID-19, and COVID-19 stress. Mediation models using the PRODCLIN method evaluated the extent to which: (1) COVID-19 impact accounted for Black-White disparities in change in insomnia, and (2) COVID-19 stress accounted for associations between discrimination and change in insomnia. Results Increases in insomnia symptoms during COVID-19 were greater in Black compared to White participants, with 4.3 times the odds of severe insomnia (Insomnia Severity Index ≥ 22). Symptom severity was associated with pre-pandemic experiences of discrimination. Black participants were also disproportionately impacted by COVID-19, with twice the odds of irreparable loss of income/employment and four times the rate of COVID-19 diagnoses in their sociofamilial network compared to White participants. The disproportionate impact of COVID-19 accounted for 69.2% of the relationship between race and change in insomnia severity, and COVID-19 related stress accounted for 66.5% of the relationship between prior history of racial discrimination and change in insomnia severity. Conclusions Black-White disparities in insomnia severity during COVID-19 may be driven by structural inequities resulting in the disproportionate impact of COVID-19 on Black Americans. Results lend support for the minority stress model in the context of sleep health. Clinical Trial Registration Sleep to Prevent Evolving Affecting Disorders (SPREAD). NCT number: NCT02988375. https://clinicaltrials.gov/ct2/show/NCT02988375.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

“…The type of population was categorized as follow: adolescents (6 studies) [ 71 , 81 , 87 , 92 , 108 , 138 ], children (1 study) [38], general population (66 studies) [ 40 , 42 , 43 , 46 , 48 , 49 ], [ [51] , [52] , [53] , [54] , [55] , [56] , [57] , 59 , 60 , [64] , [65] , [66] ], [ [68] , [69] , [70] , 72 , 73 , 76 , [78] , [79] , [80] ], [ [82] , [83] , [84] , [85] , 88 , 89 , 101 , 103 ], [ 104 , 109 , 110 , 113 , 117 , 120 , 121 ], [ 123 , 128 , 129 , 131 , 134 , 135 , 137 ], [ 139 , [141] , [142] , [143] , [144] , [145] , 147 , [150] , [151] , [152] ], [ 154 <...…”

“…The total scores ranged from 3 to 6. Most of the studies (114) [ [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ], [ [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ], [ [63] , [64] , [65] , [66] , [67] , [68] ], [ [70] , [71] , [72] , [73] , [75] , [76] , [77] ], [ [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , 91 , [93] , [94] , [95] , [96] , [97] , [98] , [99] ], [ [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [113] , …”

Worry about COVID‐19 as a predictor of future insomnia

“…First, the majority of respondents were White participants and women, which is important as some studies have found that insomnia was elevated among women during the pandemic (Kang et al, 2020 ; Li et al, 2020 ). COVID‐19 and COVID‐19‐related insomnia have disproportionately impacted Black Americans (Cheng et al, 2022 ) and it will be important to study the effect of worry on insomnia among Black participants during the COVID‐19 pandemic. Second, as is to be expected by a study that did not pay participants for survey completion, only about one‐third of participants completed all three study assessments.…”

How did trends in sleep duration in 2020 compare to previous years and how did they vary by sex, race/ethnicity, and educational attainment?

“…These findings coincide with previous research suggesting that the influence of COVID-19 specific stressors did not uniquely influence sleep quality by gender, race/ethnicity, or educational attainment [ 19 ]. The findings are troubling as during one of the most dramatic and abrupt increases in the reported sleep duration on record, sleep disparities across gender, race/ethnicity, and educational attainment remained [ 22 , 38 ]. That is, Americans seemingly consistently changed their sleep duration in the early stages of the pandemic resulting in stable levels of inequality in sleep as before the pandemic.…”

“…Black adults and Hispanic adults report significantly shorter sleep durations than non-Hispanic White adults [ 20 ]. In 2020, the pandemic disproportionately influenced non-Hispanic Black Americans and Hispanic Americans([ 21 ], including their insomnia [ 22 ]. Black Americans and Hispanic Americans who were more likely to work “frontline”, on-site jobs, and in service sectors that were economically decimated in the tens of millions [ 23 ].…”