Sleep and cardiometabolic health by government-assisted rental housing status among Black and White men and women in the United States

Housing instability and cardiometabolic health in the United States: a narrative review of the literature

Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.

A nationally representative study of aerobic activity and strength training in older cancer survivors and their psychological distress and sleep difficulties

OBJECTIVE

To examine the prevalence of different levels of aerobic activity and strength training in older cancer survivors and their associations with psychological distress and sleep difficulties.

METHODS

We used cross-sectional data from the 2016-2018 National Health Interview Survey on 3,425 survivors aged ≥ 65 years. Individuals were classified into active, insufficiently active, and inactive categories, and by whether they reported strength training at least twice per week. The outcome variables were self-reported psychological distress, trouble falling asleep, trouble staying asleep, and trouble waking up feeling rested. Multivariate logistic models were used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs).

RESULTS

Only 35.2% of older survivors reached the recommended aerobic activity guidelines, and 12% had strength training at least twice per week. A total of 626 (18.3%) reported at least moderate psychological distress, and 1,137 (33.2%) had trouble staying asleep. For survivors who reported strength training less than two times per week, being insufficiently active or inactive was associated with worse psychological distress (OR 1.52, 95% CI 1.17-1.97; OR 1.30, 95% CI 1.02-1.64) and more sleep difficulties (OR ranging from 1.33 to 2.07). Among active survivors, strength training two or more times per week was associated with more trouble staying asleep (OR 1.67, 95% CI 1.06-2.58).

CONCLUSIONS

Most older cancer survivors did not meet the recommended physical activity guidelines and suffered from psychological distress and sleep difficulties. Additional research may be needed to examine the effects of frequent muscle strength training on sleep quality.

A scoping review of racial/ethnic disparities in sleep

BACKGROUND

Despite remarkable achievements in ensuring health equity, racial/ethnic disparities in sleep still persist and are emerging as a major area of concern. Accumulating evidence has not yet been well characterized from a broad perspective. We conducted a scoping review of studies on sleep disparities by race/ethnicity to summarize characteristics of existing studies and identify evidence gaps.

METHODS

We searched PubMed, CINAHL, PsycINFO, and Web of Science databases for studies of racial/ethnic disparities in sleep. Studies that met inclusion criteria were retrieved and organized in a data charting form by study design, sleep measuring methods, sleep features, and racial/ethnic comparisons.

RESULTS

One hundred sixteen studies were included in this review. Most studies focused on disparities between Whites and Blacks. Disproportionately fewer studies examined disparities for Hispanic, Asian, and other racial/ethnic groups. Self-reported sleep was most frequently used. Sleep duration, overall sleep quality, and sleep disordered breathing were frequently studied, whereas other features including sleep efficiency, latency, continuity, and architecture were understudied, particularly in racial minority groups in the US. Current study findings on racial/ethnic disparities in most of sleep features is mixed and inconclusive.

CONCLUSIONS

This review identified significant evidence gaps in racial/ethnic disparities research on sleep. Our results suggest a need for more studies examining diverse sleep features using standardized and robust measuring methods for more valid comparisons of sleep health in diverse race/ethnicity groups.

Hispanic/Latino heritage group disparities in sleep and the sleep-cardiovascular health relationship by housing tenure status in the United States

OBJECTIVES

The objective of this study was to investigate whether the sleep-cardiovascular health (CVH) association varies by Hispanic/Latino heritage group and housing tenure status (i.e., homeownership, unassisted housing, government-assisted housing), which is an important social determinant of health.

DESIGN

Cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data.

SETTING

United States.

PARTICIPANTS

US-born/non-US-born Mexican, Puerto Rican, Cuban, Dominican, Central/South American, and US-born non-Hispanic (NH)-white adults.

MEASUREMENTS

Within each housing tenure category, Poisson regressions with robust variance estimated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of (1) habitual sleep duration (<6-hours, 6-<7-hours, and >9-hours vs. 7-9 hours) and sleep quality for Hispanic/Latino heritage groups compared with NH-whites and (2) ideal CVH for Hispanic/Latino heritage groups within each sleep duration category, separately, compared with NH-whites who reported 7-9 hours sleep duration.

RESULTS

Among 283,767 NH-white and Hispanic/Latino adults (mean age=47.0±0.09 years, 50.1% female), 33% rented housing (4% government-assisted; 29% unassisted), and 67% were homeowners. Compared with their NH-white housing tenure counterparts, only Puerto Rican homeowners were more likely to report <6-hours (PR=1.70 [95% CI: 1.44-2.01]) and 6-<7-hours (PR=1.31 [1.19-1.44]) sleep duration. Overall, Hispanic/Latino heritage groups were either less likely or no more likely to report >9-hours sleep duration and poor sleep quality compared with NH-whites. Disparities in CVH were large between Puerto Rican unassisted renters and homeowners who reported >9-hours of habitual sleep compared with their NH-white housing tenure counterparts who reported 7-9 hours.

CONCLUSIONS

Hispanic/Latino-white disparities in the sleep-CVH relationship may vary by Hispanic/Latino heritage group and housing tenure.

Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States

While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.

Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non-pregnant women in the United States

Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004-2017), we investigated relationships between self-reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non-pregnant women to report short sleep (PR_Overall  = 0.75; 95% CI, 0.68-0.82) and more likely to report long sleep (PR_Overall  = 2.06; 95% CI, 1.74-2.43) and trouble staying asleep (PR_Overall  = 1.34; 95% CI, 1.25-1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35-49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non-pregnant women (PR_White  = 0.45; 95% CI, 0.31-0.64), but this association was not observed among black women (PR_Black  = 0.98; 95% CI, 0.46-2.09) and was less pronounced among Hispanic/Latina women (PR_{Hispanic/Latina}  = 0.82; 95% CI, 0.38-1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PR_Black  = 1.35; 95% CI, 1.08-1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.

Are sleep patterns influenced by race/ethnicity - a marker of relative advantage or disadvantage? Evidence to date

Sleep is a fundamental necessity of life. However, sleep health and sleep disorders are not equitably distributed across racial/ethnic groups. In fact, growing research consistently demonstrates that racial/ethnic minorities are more likely to experience, for instance, shorter sleep durations, less deep sleep, inconsistent sleep timing, and lower sleep continuity in comparison to Whites. However, racial/ethnic disparities in reports of sleepiness and sleep complaints are inconsistent. Racial/ethnic groups have significant heterogeneity, yet within-group analyses are limited. Among the few published within-group analyses, there are differences in sleep between non-US-born and US-born racial/ethnic groups, but the group with the more favorable sleep profile is consistent for non-US-born Latinos compared to US-born Latinos and Whites but unclear for other racial/ethnic minority groups. These sleep health disparities are a significant public health problem that should garner support for more observational, experimental, intervention, and policy/implementation research. In this review, we 1) summarize current evidence related to racial/ethnic disparities in sleep health and within-group differences, focusing on the sleep of the following racial/ethnic minority categories that are defined by the United States Office of Management and Budget as: American Indian/Alaska Native, Asian, African American/Black, Hispanic/Latino, and Native Hawaiian/Pacific Islander; 2) discuss measurement challenges related to investigating sleep health disparities; 3) discuss potential contributors to sleep health disparities; 4) present promising interventions to address sleep health disparities; and 5) discuss future research directions on intersectionality and sleep health.