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

Abstract

Background: Hypertension is highly prevalent and a risk factor for cardiovascular disease (CVD). Hypertension is more common among low socioeconomic status (SES) individuals and those with poor sleep quality. Given evidence suggesting that SES is associated with poor sleep quality, sleep may link SES and hypertension. Using data from the Midlife in the United States (MIDUS) Study, we tested sleep quality as a partial mediator of socioeconomic disparities in hypertension.

 

Methods: Participants underwent 7-day actigraphy, a clinic visit for measures of blood pressure, and completed questionnaires. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) (higher WASO > 30 minutes) and sleep efficiency (SE) (low SE < 85%). SES was defined with the socioeconomic index score (SEI), which collectively assessed education, income, and occupational prestige (n=274) and educational attainment (n=426). SES indicators were dichotomized into low vs high at the sample’s median. Averaged 2nd and 3rd systolic and diastolic blood pressure readings with values ≥ 130 and 80 mmHg, respectively, were classified as hypertensive. Poisson and linear regression models were fit to examine associations between SES and sleep, sleep and hypertension or blood pressure, and SES differences in hypertension or blood pressure with sleep. Covariates included age, gender, race, BMI, and perceived stress. Mediation was tested using Poisson regression models.

Results: The sample had an average age of 55.8 years (average SD: 12.1), and 59.2% female, 53.4% White, 41.4% Black, and 5.3% mixed race; 77.7% had higher WASO, 67.5% had low SE, and 60.8% were hypertensive. In unadjusted analyses SEI was associated with a higher prevalence of hypertension, but was attenuated with adjustment for race.In adjusted analyses, SES was not associated with sleep measures or hypertension after adjustment for covariates. Individuals with high vs. low SE 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 diastolic blood pressure (β = -2.59, 95% CI [-5.00, 0.18]) after adjustment for covariates. There was no evidence of mediation.

 

Conclusions: Effective interventions for decreased hypertension should consider strategies that target SE. Future research should explore the intersectionality of race and SES which may impact sleep quality and hypertension. Improvement of sleep quality may optimize hypertension management.

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	socioeconomic status hypertension sleep sleep efficiency MIDUS educational attainment WASO blood pressure
Committee Chair / Thesis Advisor	Johnson, Dayna A., Emory University

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