Abstract 33: Using the AHA's Life Essential 8 Criteria to Assess Sleep Duration and Its Association With Social Determinants of Health in U.S. Children

Abstract

Introduction: In 2010, the American Heart Association (AHA) began using 7 indicators to measure cardiovascular health, known collectively as Life’s Simple 7. In June 2022, the AHA added an 8 th indicator: sleep duration. Although earlier studies have examined whether/how the indicators in Life’s Simple 7 might be impacted by social determinants of health (SDoH), few epidemiological studies have examined how SDoH influence the 8 th indicator in U.S. children. Purpose: We used the AHA Life Essential 8 scoring criteria to assess sleep duration among U.S. children and whether certain SDoH were associated with sleep duration. Methods: We utilized data from the 2019-2020 National Survey of Children’s Health. For all children, we calculated the score for sleep duration (range 0 [lowest] to 100 [highest]). Based on the AHA scoring algorithm and the distribution of sleep duration, participants were divided into three mutually exclusive subgroups: (1) those who met age-appropriate optimal sleep duration; (2) those who had 1-<2 hour below or ≥ 1 hour above optimal sleep duration; and (3) those who had ≥ 2 hours below optimal sleep duration. Multinomial logistic regressions were used to assess the association of sleep duration with 4 SDoH factors (adverse childhood experiences [ACEs], received preventive care during past 12 months, food insufficiency, and living in unsafe neighborhoods). We controlled for child’s sex, age, race/ethnicity, and household poverty level. Results: Among children aged 6 to 17 years (n=49,821), the mean sleep duration score was 77.1 (95% CI 76.4 to 77.7) and 65.5% of the children had age-appropriate optimal sleep scores. Three SDoH factors were associated with higher likelihood of suboptimal sleep duration. Adjusting for covariates, for each point increase in number of ACEs the likelihood of having suboptimal sleep duration was increased (relative risk ratios [RR]:1.05 [95% CI 1.02 to 1.09]; 1.21 [95% CI 1.15 to 1.27]). The likelihood of having suboptimal sleep duration was also increased for those who reported food insufficiency at home (RR:1.19 [95% CI 1.06 to 1.33]; 1.67 [95% CI 1.40 to 1.98]) as well as for those who reported living in an unsafe neighborhood (RR: 1.34 [95% CI 1.04 to 1.71]; 1.63 [95% CI 1.19 to 2.23]). Conclusions: Our findings show that using the AHA’s Life Essential 8 scoring criteria, one third of U.S. children do not meet optimal sleep duration standards. These findings highlight the need for greater attention to social and systemic influences on children's sleep health. It is critical for healthcare providers to recognize that suboptimal sleep duration is a risk factor for poor cardiovascular health, and that certain SDoH are associated with suboptimal sleep duration.