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

• Type of Material: Article
• Authors: Shona C Fang, Harvard University; S.V. Subramanian, Harvard University; Rebecca Piccolo, New England Research Institutes, Inc.; May Yang, New England Research Institutes, Inc.; H Klar Yaggi, Yale University; Donald Bliwise, Emory University; Andre B. Araujo, New England Research Institutes, Inc.
• Language: English
• Date: 2015-01-01
• Publisher: BMJ Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015, British Medical Journal
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/jech-2013-203256
• Title of Journal or Parent Work: Journal of Epidemiology and Community Health
• ISSN: 0143-005X
• Volume: 69
• Issue: 1
• Start Page: 63
• End Page: 69
• Grant/Funding Information: Funding for this research was provided by the National Institute on Minority Health and Health Disparities R21MD006769 the National Institute of Diabetes and Digestive and Kidney Diseases U01DK056842.
• Keywords: DESIGN; ASSOCIATIONS; ADHERENCE; DISEASE; DISTURBANCE; UNITED-STATES; QUALITY; Science & Technology; Life Sciences & Biomedicine; NEIGHBORHOOD; RISK; RESIDENCE; Public, Environmental & Occupational Health
• Research Categories: Biology, Neuroscience; Health Sciences, Public Health

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.