Sleep is essential to human health. Sleep problems affect a substantial proportion of the US population and cost the US healthcare system hundreds of billions of dollars annually. At the same time, social disparities (including those related to age, sex, socioeconomic status (SES), and race/ethnicity) in health have been repeatedly documented. The current literature on social disparities in sleep is in conflict regarding the existence of social disparities, their origins, and how social disparities in sleep may manifest themselves in social disparities in health. The overall objective of this application is to make cost-efficient use of an existing data resource [the Boston Area Community Health (BACH) Survey;U01DK056842)] in order to close key knowledge gaps regarding the mechanisms linking social determinants with sleep, as well as mechanisms underlying the way in which social disparities in sleep manifest themselves in downstream health disparities. The BACH Survey is a population-based, random-sample, cohort study that included 5,506 diverse (white, Hispanic, black) women and men between the ages of 30-79 y at baseline;4,145 subjects were recently re- interviewed (83% response rate) 5 years later. The BACH Survey database will be linked with publically- available data [(i.e., US Census Bureau and EPA] for a number of the proposed analyses. There are two specific aims. (1) Examine the influence that social determinants have on sleep. This will include estimating (using multi-level modeling) the individual- and neighborhood-level social determinants of sleep quantity, sleep quality, and use of prescription and non-prescription sleep aids, determining the extent to which the associations between individual- and neighborhood-level social determinants and sleep are driven by other risk factors, including pain and voiding symptoms, and quantifying the relationship of external noise and air pollution (by geo-spatial analytic techniques) with sleep quantity, sleep quality, and use of prescription and non-prescription sleep aids. (2) Examine the associations between sleep and health outcomes. This will include examining age-, sex-, SES-, and race/ethnic group-specific longitudinal associations between sleep measured at baseline in relation to incident hypertension, obesity, diabetes, cardiovascular disease, and all- cause mortality and identifying variables that may be on the pathway (e.g., nutrition, inflammation, psychosocial stress, depression, use of sleep-related medications) between sleep and these health outcomes. This cost- and time-efficient study of social determinants, sleep, and health has the potential to fill critical gaps in the literature within the framework of a new conceptual approach that integrates novel data using state-of- the-art statistical techniques. The use of the R21 mechanism will serve as a springboard for the investigators to initiate additional studies in the area of sleep. Given the emerging relevance of sleep as a critical factor in human health, the potential scientific impact of the proposed study is substantial.
The proposed work is an observational research study examining the complex relationships of social factors, sleep, and health outcomes in a population-based sample of racially/ethnically diverse men and women aged 30-79 y. Findings will inform our understanding of the population distribution of sleep and its effects on health.
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