Decomposition of racial and ethnic disparities in sleep health among US adults, NHANES from 2005-2008 and 2015-2018.

backgroundSome studies have shown racial and ethnic disparities in sleep debt, trouble sleeping, and daytime sleepiness, as well as the association between social demographics and sleep behaviors, such as educational level, ethnic origin, and marital status. However, most existing studies do not quantify the extent to which group-level disparities are explained by differences in the distribution of these factors. The present study employs Blinder-Oaxaca decomposition to examine the contributions of individual-level factors to disparities in average healthy sleep scores across diverse race and ethnicity groups, to inform strategies to mitigate healthy sleep pattern inequities.

methodsIn the National Health and Nutrition Examination Surveys (NHANES) from 2005-2008 and 2015-2018, Blinder-Oaxaca decomposition was used to assess the extent to which differences in individual-level factors (age, sex, marital status, education level, smoking status, alcohol intake, physical activity, BMI, place of birth, food security, health insurance, and household income) explain racial and ethnic disparities in average healthy sleep scores among Hispanic, non-Hispanic Black adults, or other races compared with non-Hispanic White adults. The healthy sleep score was constructed based on five components: 7-8 h of sleep per day, no trouble sleeping, no snoring, no excessive daytime sleepiness, and no nocturia. Each component was assigned 1 point for a favorable status.

resultsAmong 17,476 participants (who represent an estimated 109,108,231 non-institutionalized US adults aged ≥ 20 years after applying sample weights), 67.8% were non-Hispanic White adults, 13.7% were Hispanic adults, 10.9% were non-Hispanic Black adults, and 7.6% belonged to other racial/ethnic groups. Among US adults, average (SE) healthy sleep score was 3.12 (0.03) in Hispanic, 2.84 (0.02) in non-Hispanic Black, 3.03 (0.02) in non-Hispanic White, and 3.15 (0.04) in other race/ethnicity adults. Blinder-Oaxaca decomposition analysis showed that education level, age, food security, and BMI were important components in explaining disparities in healthy sleep scores among racial and ethnic groups. Specifically, compared with non-Hispanic White adults, higher educational level and lower prevalence of food insecurity among non-Hispanic Black adults were associated with higher healthy sleep scores (differences attributable to education: +0.03 [SE = 0.01]; to food security: +0.06 [SE = 0.01], both P < 0.001). Similarly, among Hispanic adults, younger average age and lower educational level were associated with higher healthy sleep scores (differences attributable to age: +0.08 [SE = 0.01]; to education: +0.11 [SE = 0.03], both P < 0.001).

conclusionsFactors such as education level, age, food security, and BMI substantially contribute to the racial and ethnic disparities in average healthy sleep scores among US adults.