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

• Type of Material: Article
• Authors: Philip Cheng, Henry Ford Health System; Melynda D Casement, University of Oregon; Ruby Cuellar, University of Oregon; Dayna Johnson, Emory University; David Kalmbach, Henry Ford Health System; Andrea C Castelan, Henry Ford Health System; Christopher L Drake, Henry Ford Health System
• Language: English
• Date: 2022-01-11
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/sleep/zsab242
• Title of Journal or Parent Work: SLEEP
• Volume: 45
• Issue: 1
• Grant/Funding Information: PC is funded by the National Heart Lung and Blood Institute (K23HL138166). DJ is funded by the National Heart Lung and Blood Institute (K01HL138211).
• Keywords: Neurosciences & Neurology; discrimination; MENTAL-HEALTH; health disparities; COVID-19; RACE/ETHNICITY; TRAJECTORIES; RACIAL/ETHNIC DIFFERENCES; DISCRIMINATION; QUALITY-OF-LIFE; Neurosciences; GUIDELINE; minority stress; INSOMNIA SEVERITY INDEX; Clinical Neurology; MEDIATION ANALYSIS; Science & Technology; insomnia; Life Sciences & Biomedicine; PATTERNS
• Research Categories: Health Sciences, Epidemiology; Psychology, General

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).