Understanding the role of structural racism in sleep disparities: a call to action and methodological considerations

Johnson, Dayna A.; Reiss, Benjamin; Cheng, Philip; Jackson, Chandra L.

doi:10.1093/sleep/zsac200

Cited by 16 publications

(5 citation statements)

References 19 publications

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“…Using estimates from BRFSS, the largest data set, the findings imply a 2.7% to 4.6% increase in probability of reporting short sleep and a 6.5% to 11.4% increase in reporting very short sleep after exposures. Consistent with the episodic nature of the exposure, the estimates were an order of magnitude lower than previously published associations between other, more sustained, sequelae of structural racism—for example, exposure to neighborhood violence, occupational stratification and shift work, and individual experiences of discrimination—and sleep duration (relative increases in sleep duration for these exposures generally range from 15% to 50%) . Nevertheless, the present study’s estimates are substantively important, equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity between Black and White individuals in very short sleep.…”

Section: Discussionsupporting

confidence: 85%

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Venkataramani,

Bair,

Bor

et al. 2024

JAMA Intern Med

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ImportanceRacial disparities in sleep health may mediate the broader health outcomes of structural racism.ObjectiveTo assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.Design, Setting, and ParticipantsTwo distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023.ExposuresOccurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent’s residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview.Main Outcomes and MeasuresSelf-reported total sleep duration (hours), short sleep (&lt;7 hours), and very short sleep (&lt;6 hours).ResultsData from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep.Conclusions and RelevanceSleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

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Section: Discussionsupporting

confidence: 85%

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Venkataramani,

Bair,

Bor

et al. 2024

JAMA Intern Med

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“…Youth may experience psychological stress through direct exposure to such discrimination, or indirectly through a stressful family environment ( Tsai et al, 2018 ) due to these mechanisms. issues of structural discrimination such as pervasive segregation, lack of access to acceptable housing, and lack of access to health services may also contribute to racial and socioeconomic differences in sleep behaviours through environmental factors ( Johnson et al, 2022 ; Papadopoulos & Sosso, 2023 ; Weinstein et al, 2017 ). While Canada has codified multiculturalism and non-discrimination based on race, ethnicity, sex or gender ( Cotter, 2019 ), racialized Canadian youth ( Okoye et al, 2023 ) and girls ( Girl Guides of Ontario, 2018 ) still report experiencing higher rates of discrimination compared to White youth and boys respectively.…”

Section: Introductionmentioning

confidence: 99%

Sleep duration change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity

Duncan

Mitchell

Riazi

et al. 2023

SSM - Population Health

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“…These findings were surprising considering SCCS participants with an optimal sleep duration trajectory were more likely to identify as White and the welldocumented sleep disparities and greater cardiovascular risk observed among both Black and African American adults and in low-income communities. 24,30,31 Although the Black and low-SES participants in the SCCS were more likely to have suboptimal sleep trajectories, our results suggest the potential health effects of suboptimal sleep may be weaker in these populations. This may be due in part to the presence of more risk factors (e.g.…”

Section: Discussionmentioning

confidence: 70%

“…While hypothesis generating, these results suggest that there may be other factors, beyond the social constructs of race and income, such as physical and social environments or occupational factors, that are not being captured and may negatively affect sleep health and ultimately contribute to mortality. 31 These results also highlight the importance of examining sleep health in new samples that offer more diverse representation not only in terms of race, but also in geography and SES.…”

Section: Discussionmentioning

confidence: 87%

Associations of Long-term Sleep Duration Trajectories with Overall and Cause-Specific Mortality Among Middle-to-older Aged Black and White Adults

Full,

Shi,

Lipworth

et al. 2024

Preprint

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BackgroundBoth short and long sleep durations are adversely associated with numerous chronic conditions, including cardiovascular disease (CVD), diabetes, hypertension, and mortality. The American Academy of Sleep Medicine recommends adults in the United States sleep at least 7 hours and less than 9 hours per night to maintain optimal health. It remains unclear how sleep duration trajectories over time are associated with mortality.MethodsThis observational cohort study includes 46,928 Black and White adults (mean age: 53 ± 9 years) who enrolled in the Southern Community Cohort Study between 2002–2009 and completed a follow-up survey in 2008-2013. Participants were categorized into nine sleep duration trajectory categories based on the reported average sleep duration between study enrollment and at follow-up. Participant vital status and date and cause of death were ascertained via linkage to the National Death Index through 2022. Cox regression analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between sleep duration trajectory and all-cause and cause-specific mortality (CVD, cancer, and neurodegenerative disease) after adjustment for sociodemographic characteristics, health behaviors, and clinical factors.ResultsDuring a median 12.6 years of follow-up, we documented 13,579 deaths, including 4,135 from CVD, 3,067 from cancer, and 544 from neurodegenerative diseases. Compared to the optimal sleep duration trajectory (maintaining 7-9 hours), all sub-optimal trajectories were associated with significant 6 to 33% greater risk of all-cause mortality in fully adjusted models. Compared to the optimal sleep trajectory, three of the sub-optimal trajectories were associated with increased CVD mortality, with HRs ranging from 1.20 to 1.34. The short-long trajectory was associated with the greatest risk of all-cause mortality (HR:1.33; 95%CI: 1.21, 1.46) and the long-short trajectory was associated with the greatest CVD mortality risk (HR:1.34; 95%CI: 1.10, 1.65). The healthy-long trajectory was associated with the greatest risk of cancer mortality (HR: 1.19; 95%CI:1.00, 1.41). None of the sub-optimal trajectories was associated with neurodegenerative disease mortality.ConclusionsSuboptimal sleep duration trajectories were associated with increased risk of all-cause mortality as well as CVD mortality. Findings highlight the importance of maintaining healthy sleep duration throughout midlife to reduce mortality risk.

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Understanding the role of structural racism in sleep disparities: a call to action and methodological considerations

Cited by 16 publications

References 19 publications

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Sleep duration change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity

Associations of Long-term Sleep Duration Trajectories with Overall and Cause-Specific Mortality Among Middle-to-older Aged Black and White Adults

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