The Role of the Physical Environment in Racial Disparities in Sleep Duration Open Access
Medearis, Krysta (Spring 2022)
Published
Abstract
Background: Racial minorities are more likely to have shorter sleep duration; however, the mechanism is unclear. Recent studies have found that the neighborhood environment is associated with sleep duration. Thus, the neighborhood environment may explain racial sleep disparities. This study examined the role of the physical environment in racial differences in sleep duration among men and women (N=2020) in the Multi-Ethnic Study of Atherosclerosis.
Methods: Participants underwent 1-week actigraphy, completed questionnaires on the neighborhood environment, and addresses were geocoded and linked to physical environment features. Actigraphy-measured sleep duration was analyzed as both continuously and categorically (short sleep duration < 6 hours vs. > 6 hours). Physical environment characteristics included availability of healthy foods, aesthetic quality, walking environment, walking destination density, the proportion of land dedicated to retail space and the overall built environment. Multi-level linear and Poisson regression models with robust variance were fit to examine the associations of race, the physical environment, and sleep duration with adjustment for covariates.
Results: The mean age was 68.5 9.1 years. Approximately 46% of participants were male and 37.8% White, 26.9% Black, 21.9% Hispanic, and 11.3% Chinese American. There was a high prevalence of short sleep duration, 31% slept < 6 hours and 62.8% slept <7 hours. The prevalence of short sleep (6 hours) was highest for racial minorities, ranging from 32.2% to 44.3% compared to 19.2% for White adults. Hispanic individuals were more likely to live in areas with lower aesthetic quality and in areas with a higher walking destination density. Chinese individuals were more likely to live in areas with a lower score for walking environment and a low built environment factor score. Black participants were more likely to reside in areas with less availability of healthy food. A standard deviation increase in neighborhood aesthetic quality was associated with sleeping 4.5 minutes longer on average, (=4.5, 95% CI: 0.9, 8.0). Whereas individuals living in areas with more walking destinations (=-8.1, 95% CI: -11.6, -4.7), a higher proportion of land dedicated to retail space (=-6.5, 95% CI: -9.9, -3.0), and a higher built environment factor score (=-8.8, 95% CI: -12.3, -5,3) had a shorter sleep duration. The physical environment partially explained some of the racial disparities in sleep duration between Hispanic or Chinese (but not Black) and White adults. The Hispanic-White difference in sleep duration was attenuated from 10.4 minutes (95% CI: -20.1, -0.7) to 9.5 minutes (95% CI: -19.2, 0.3) with adjustment for aesthetic quality. The Hispanic-White difference was further attenuated to 6.7 minutes (95% CI: -16.5, 3.1), 9.0 minutes (95% CI: -18.7, 0.8), and 4.8 minutes (95% CI: -14.7, 5.1) with adjustment for walking destination density, proportion of land dedicated to retail space, and the built environment factor score, respectively. The Chinese-White difference in sleep duration was attenuated from 31.4 minutes (95% CI: -43.5, -19.3) to 29.0 minutes (95% CI: -41.2, -16.9) with adjustment for proportion of land dedicated to retail space.
Conclusion: Black, Hispanic, and Chinese individuals had shorter sleep duration than White individuals. Physical environment features explained some of the Hispanic and Chinese-White differences in sleep duration. This study provides support that the physical environment may be an important mechanism in which racial disparities in sleep exist and is a likely a point of intervention.
Table of Contents
INTRODUCTION……………………………………………………………………………...1
METHODS……………………………………………………………………………………...6
RESULTS…………………………………………………………………………………….….11
DISCUSSION……………………………………………………………………………….....15
TABLES AND FIGURES…………………………………………………………………......22
REFERENCES………………………………………………………………………………….33
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