Study Shows Sleep Disparities More Prevalent in African Americans

César Caraballo, MD

A new cross-sectional study found that the prevalence of short and long sleep duration was persistently higher in Black Americans from 2004 to 2018.

Additionally, the disparities in short sleep duration seemed to be highest among women of middle or high income status and in young or middle-aged adults. Investigators believed that these complications with sleep were associated with other health disparities.

Investigators noted that historically marginalized racial and ethnic groups are more likely to experience sleep deficiencies that in turn result in racial and ethnic disparities in physical and mental health.

Additionally, little information exists regarding trends in racial and ethnic disparities regarding sleep health.

As such, investigators led by César Caraballo, MD, Center for Outcomes Research and Evaluation at Yale New Haven Hospital, Connecticut, evaluated the temporal trends in racial and ethnic disparities in sleep duration during a 15-year period in the US

The team utilized representative data from the National Health Interview Survey (NHIS) to also evaluated the racial and ethnic differences in the association between sleep duration and age.

Harmonized data form the integrated Public Use Microdata Series Health Surveys, which included NHIS strata, primary sampling unit, and person weights were also utilized.

Individuals who were 18 years or older from the 15-year study period of the NHIS were included in the study, and any respondents with missing sleep data were excluded.

From there, participants were classified into 4 mutually exclusive racial and ethnic subgroups including non-Hispanic Asian, non-Hispanic Black or African American, Hispanic or Latino, and non-Hispanic White.

Participants were asked to respond to the question, “On average, how many hours of sleep do you get in a 24-hour period?”. Recommended sleep duration was 7-9 hours, short sleep duration was fewer than 7 hours, and long sleep duration was more than 9 hours.

Among the 444,743 adults interviewed during the 15-year study period, 10,203 (2.3%) were excluded based on missing information on sleep duration. An additional 3340 people who identified as non-Hispanic Alaskan Native or American Indians and 1905 who identified as non-Hispanic were excluded due to small numbers.

The study sample included 429,195 individuals, 51.7% of whom were women. Among the different race and ethnic groups featured, 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White.

In the beginning of the study period (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.

Investigators observed a significant increase in short sleep prevalence among Black (6.39 percentage points), Hispanic or Latino (6.61) and White (3.22) participants during the study (P<.001).

Meanwhile, prevalence of long sleep changed significantly only in Hispanic or Latino individuals (−1.42 [95%CI, −2.52 to−0.32] percentage points) (P = .01).

Furthermore, by 2018 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, compared to White individuals, and long sleep prevalence was higher only among Black individuals (1.44 [95%CI, 0.39-2.48] percentage points) (P = .007).

Investigators suggested that the findings of the study had implications for the structure of public health interventions and suggested that increased efforts should be made to improve sleep health in historically disenfranchised racial and ethnic groups.

“The observed persistent—and growing—disparities in sleep duration serve as anadditional indicator of the consequences of the artificial hierarchy in which racial and ethnic minority individuals encounter higher barriers to maintaining a healthy life, including income distribution inequality, racial segregation, restricted access to medical care, and exposure to social and environmental conditions that affect health and sleep,” the team wrote. “Thus, and as with other disparities, public policies may be ineffective at eliminating these racial and ethnic disparities in sleep duration without accounting for systemic racism as a fundamental cause.”

The study, "Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018," was published online in JAMA Network Open.