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Petrovic D, Haba-Rubio J, de Mestral Vargas C, Kelly-Irving M, Vineis P, Kivimäki M, Nyberg S, Gandini M, Bochud M, Vollenweider P, d’Errico A, Barros H, Fraga S, Goldberg M, Zins M, Steptoe A, Delpierre C, Heinzer R, Carmeli C, Chadeau-Hyam M, Stringhini S. The contribution of sleep to social inequalities in cardiovascular disorders: a multi-cohort study. Cardiovasc Res 2020; 116:1514-1524. [PMID: 31754700 PMCID: PMC7425783 DOI: 10.1093/cvr/cvz267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/28/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Sleep disturbances exhibit a strong social patterning, and inadequate sleep has been associated with adverse health outcomes, including cardiovascular disorders (CVD). However, the contribution of sleep to socioeconomic inequalities in CVD is unclear. This study pools data from eight European cohorts to investigate the role of sleep duration in the association between life-course socioeconomic status (SES) and CVD. METHODS AND RESULTS We used cross-sectional data from eight European cohorts, totalling 111 205 participants. Life-course SES was assessed using father's and adult occupational position. Self-reported sleep duration was categorized into recommended (6-8.5 h/night), long (>8.5 h/night), and short (<6 h/night). We examined two cardiovascular outcomes: coronary heart disease (CHD) and stroke. Main analyses were conducted using pooled data and examined the association between life-course SES and CVD, and the contribution of sleep duration to this gradient using counterfactual mediation. Low father's occupational position was associated with an increased risk of CHD (men: OR = 1.19, 95% CI [1.04; 1.37]; women: OR = 1.25, 95% CI [1.02; 1.54]), with marginal decrease of the gradient after accounting for adult occupational position (men: OR = 1.17, 95% CI [1.02; 1.35]; women: OR = 1.22, 95% CI [0.99; 1.52]), and no mediating effect by short sleep duration. Low adult occupational position was associated with an increased risk of CHD in both men and women (men: OR = 1.48, 95% CI [1.14; 1.92]; women: OR = 1.53, 95% CI [1.04; 2.21]). Short sleep duration meaningfully contributed to the association between adult occupational position and CHD in men, with 13.4% mediation. Stroke did not exhibit a social patterning with any of the variables examined. CONCLUSION This study suggests that inadequate sleep accounts to a meaningful proportion of the association between adult occupational position and CHD, at least in men. With sleep increasingly being considered an important cardiovascular risk factor in its own terms, our study additionally points to its potential role in social inequalities in cardiovascular disease.
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Affiliation(s)
- Dusan Petrovic
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos de Mestral Vargas
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Michelle Kelly-Irving
- INSERM, UMR 1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Solja Nyberg
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Murielle Bochud
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Peter Vollenweider
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Angelo d’Errico
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Silvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cyrille Delpierre
- INSERM, UMR 1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Cristian Carmeli
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Silvia Stringhini
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
- Unit of Population Epidemiology, Primary Care Division, Geneva University Hospital, Geneva, Switzerland
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