HEALTHCARE FINANCIAL HARDSHIP AND HABITUAL SLEEP DURATION, IMPACT ON SLEEP DISPARITIES, AND IMPACT ON THE SLEEP-OBESITY RELATIONSHIP
AdvisorGrandner, Michael A.
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PublisherThe University of Arizona.
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AbstractIntroduction: Sleep is related to socioeconomics and can impact 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 were obtained from the 2017 Behavioral Risk Factor Surveillance System (N=39,267 from 7 states provided complete data on all variables). 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 on average (B=-0.26,95%CI[-0.35, 0.17],p<0.0005). There was an interaction with race/ethnicity, such that 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%), typical relationships were seen, with both high and low sleep duration being 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 these 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.
Degree ProgramHonors College
Neuroscience and Cognitive Science