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. 2022 Apr 1;5(4):e226385.
doi: 10.1001/jamanetworkopen.2022.6385.

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

César Caraballo  1   2 , Shiwani Mahajan  1   3 , Javier Valero-Elizondo  4   5 , Daisy Massey  1 , Yuan Lu  1   2 , Brita Roy  3   6 , Carley Riley  7   8 , Amarnath R Annapureddy  2 , Karthik Murugiah  1   2 , Johanna Elumn  9 , Khurram Nasir  4   5 , Marcella Nunez-Smith  10 , Howard P Forman  11 , Chandra L Jackson  12   13 , Jeph Herrin  2 , Harlan M Krumholz  1   2   14
Affiliations

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

César Caraballo et al. JAMA Netw Open. .

Abstract

Importance: Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years.

Objective: To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US.

Design, setting, and participants: This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022.

Exposures: Self-reported race, ethnicity, household income, and sex.

Main outcomes and measures: Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age.

Results: The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age.

Conclusions and relevance: The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lu reported receiving grants from the National Heart, Lung, and Blood Institute and the Yale Center for Implementation Science outside the submitted work. Dr Roy reported consulting for the Institute for Healthcare Improvement. Dr Riley reported receiving personal fees from Heluna Health and consulting for the Institute for Healthcare Improvement outside the submitted work. Dr Nasir reported serving on the advisory boards of Novartis International AG, Esperion Therapeutics Inc, and Novo Nordisk. Dr Krumholz reported receiving expenses and/or personal fees from UnitedHealthcare, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried & Jensen law firm, the Arnold & Porter law firm, and the Martin Baughman law firm; being a co-founder of Refactor Health and Hugo Health; and being associated with contracts through Yale New Haven Hospital from the Centers for Medicare & Medicaid Services and through Yale University from Johnson & Johnson outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Overall Annual Estimated Prevalence of Short Sleep Duration by Race and Ethnicity Among US Adults
Short sleep duration was defined as self-reported sleep duration of fewer than 7 hours in a 24-hour period (data source: National Health Interview Survey, 2004-2018). Annual prevalence estimates were obtained using multinomial logistic regression adjusted by age and US region (details are found in the Methods section and the eMethods in the Supplement). Error bars represent 95% CIs.
Figure 2.
Figure 2.. Overall Annual Estimated Prevalence of Long Sleep Duration by Race and Ethnicity Among US Adults
Long sleep duration was defined as self-reported sleep duration of more than 9 hours in a 24-hour period (data source: National Health Interview Survey, 2004-2018). Annual prevalence estimates were obtained using multinomial logistic regression adjusted by age and US region (details are found in the Methods section and eMethods in the Supplement). Error bars represent 95% CIs.
Figure 3.
Figure 3.. Association Between Age and Short and Long Sleep Duration by Race and Ethnicity Among US Adults
Short sleep duration was defined as self-reported sleep duration of fewer than 7 hours in a 24-hour period; long sleep duration, self-reported sleep duration of more than 9 hours in a 24-hour period (data source: National Health Interview Survey, 2004-2018). Prevalence estimates for each age group were obtained using multinomial logistic regression (details are found in the Methods section and the eMethods in the Supplement). Error bars represent 95% CIs.
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