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Author Notes:

Correspondence to Dr Shona C Fang; sfang@neriscience.com.

ABA, HKY, SVS, DLB and RP conceived of the study question.

SCF, RP, MY and ABA developed the study design and analysis plan with input from DLB, SVS and HKY.

SCF and MY analysed the data.

SCF drafted the article and all authors reviewed and provided input to the article, contributed to interpretation of data and approved the version submitted for publication.

Competing interests: None.

Ethics approval: The study was approved by the Institutional Review Board of the New England Research Institutes, Inc.


Research Funding:

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.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • RISK

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


Journal Title:

Journal of Epidemiology and Community Health


Volume 69, Number 1


, Pages 63-69

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2015, British Medical Journal

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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