The widening gap in all-cause and CVD-mortality and morbidity rates in rural and urban America is at an all- time high. Latino/as, the largest minority ethnic group in the U.S., appear to be most affected by rural-urban divide in CVD outcomes, as they are disproportionately burdened by CVD risk (overweight/obesity, hypertension, dyslipidemia, diabetes) and CVD mortality (20%, 2nd leading cause of death among Latino/as) relative to other racial/ethnic groups. Unlike other groups where individuals in rural and urban areas have differing CVD risk, rural and urban Latino/as have similarly high rates of CVD risk. Although, healthy diets/ nutrition, smoking cessation, and regular physical activity are linked to CVD risk, they have not been very effective in reducing the CVD burden among racial/ethnic groups, specifically among Latino/as. Several studies indicate that insufficient sleep (<7hrs./day) explains a significant amount of the CVD burden among Latino/as. Preliminary evidence indicates that insufficient sleep may contribute to the observed CVD burden among Latino/as, as Latino/as have greater odds of experiencing insufficient sleep compared with non-Hispanic whites. Evidence also shows that insufficient sleep, which is associated with potentially life-threatening CVD, is a key modifiable risk factor with great potential to reduce health disparities. However, it is unclear what factors contribute to insufficient sleep (IS) disparities and IS-related CVD burden among rural and urban Latino/as. To address these gaps, we will enroll 525 Latino/as in rural and urban communities to participate in home-based studies using novel mHealth devices. The multidisciplinary team will: 1) identify behavioral, genetic, psychosocial, and environmental factors that are associated with insufficient sleep and IS-related CVD and 2) assess effects of insufficient sleep on CVD risk markers (obesity, blood pressure, lipid profile, and fasting plasma glucose/ HbA1C) and inflammatory risk markers (IL-6, IL-10, and TNF-?). This study will provide multi-level evidence supporting epidemiological findings of greater rates of insufficient sleep among Latino/as, which may explain their disproportionate burden of CVD risk. It will also assess whether and why rural and urban differences in IS exist among Latino/as and how that may lead to IS-related CVD outcomes. These data will provide: 1) the foundation for interventions to mitigate adverse effects of insufficient sleep on CVD health outcomes, 2) evidence to delineate factors underlying insufficient sleep and CVD burden among Latino/as in rural and urban settings, and 3) a possible explanation of behavioral, genetic, environmental and psychosocial determinants of insufficient sleep and related CVD risk factors in rural and urban Latino/as. Findings can lead to actionable clinical, lifestyle, and policy interventions to improve Latino health.
This proposal is predicated upon compelling data that Latino/as exhibit a greater risk of insufficient sleep (<7 hours) compared with whites, and that insufficient sleep is associated with increased risk of cardiovascular disease and inflammation. It will provide multi-level evidence on behavioral, genetic, psychosocial and environmental determinants of insufficient sleep and sleep-related CVD risk and inflammation markers among rural and urban Latino/as. These data will provide the foundation for interventions to mitigate adverse effects of insufficient sleep on health outcomes.
