Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study

Abstract

Introduction: Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension. Methods: We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274). Results: Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (> 30 minutes), low SE (<85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation. Conclusions: Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.