Abstract
Background: Social determinants of health (SDoH) play a critical role in sleep. Patients with multiple cardiovascular disease (CVD) risk factors are vulnerable to poor sleep. Few studies have examined SDoH related to poor sleep in this vulnerable group. Therefore, we focused on adults with all three CVD risk factors - hypertension, diabetes, and obesity- and examined the relationships between SDoH and sleep outcomes. Methods: We analyzed data from the 2013-2018 National Health Interview Survey among adults with hypertension, obesity and diabetes. Sleep outcomes included sleep duration (categorized as <7, 7-9, >9 hours), days having trouble falling asleep, and days having trouble staying asleep (both categorized as no trouble, 1-3, 4-7 days). We used multivariable logistic regression to examine the relationship between SDoH (race, sex, education, income, marital status, employment status, and neighborhood cohesion) and sleep outcomes. Results: The sample included 9,695 adults aged 62 (±12) years. Over half slept either < 7 or > 9 hours, and 44.2% and 51.2% reported having trouble falling and staying asleep, respectively. Black adults were more likely to sleep < 7 hours compared to white adults (OR=1.32, 95% CI: 1.00-1.74). Income > $100,000 was significantly related to having trouble staying asleep (OR=1.87, 1.01-3.46) in comparison to income < $35,000. Compared to adults who lived in neighboordhood with higher social cohesion, those in neighborhoods with lower social cohesion were more likely to sleep < 7 hours (OR=1.57, 1.24-1.99) and have trouble staying asleep (OR=1.36, 1.07-1.74). Unemployed adults were less likely to sleep > 9 hours and experience trouble falling or staying asleep. Conclusions: Race, income, employment status, and neighborhood cohesion were related to sleep among adults with hypertension, diabetes, and obesity. Targeted sleep interventions should be implemented for high-risk patients who experience specific characteristics of SDoH.
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