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Abstract

Introduction

Sleep is related to socioeconomic status and impacts health. This study evaluated whether foregoing medical care due to cost impacts sleep and plays a role in sleep disparities and the sleep-obesity relationship.

Methods

Data from the 2017 Behavioral Risk Factor Surveillance System (N=39,267 from 7 states). Sleep duration was assessed as hours/day. Participants were asked, “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?” They were also asked for information about age, sex, race/ethnicity, education, income, employment, overall health, and access to health insurance. They were also asked for height/weight, which was used to compute body mass index (BMI).

Results

Access to health insurance was not associated with habitual sleep duration. However, foregoing medical care was associated with less sleep (B=-0.26, 95%CI[-0.35,-0.17], p<0.0005). There was an interaction with race/ethnicity; compared to non-Hispanic Whites, the effect was 115% larger among Blacks/African-Americans, 13% larger in Hispanics/Latinos, 101% larger and in the opposite direction for Asians, and non-significant for Multiracial. Race/ethnicity relationships to sleep duration were stratified by foregoing care. Among those who did not (90%), both short and long sleep duration were more likely among Blacks/African-Americans and other minority groups. Among those who did forego care (10%), these effects were dramatically reduced. Further, when sleep duration was evaluated as a predictor of obesity, this relationship was only seen among those who did not forego care.

Conclusion

Foregoing medical care due to cost is an independent risk factor for insufficient sleep, irrespective of income, employment, and access to insurance. It disproportionately affects Blacks/African-Americans and may represent part of the reason why sleep disparities exist even after adjustment for most socioeconomic indices. Further, foregoing medical care may present such health risks that this subsumes the relationship between sleep and obesity.

Support (If Any)

R01MD011600

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© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://dbpia.nl.go.kr/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Topic:
Issue Section:
XI. Sleep Deprivation
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