Abstract
Objectives:
The current study examined the role of emotional distress in explaining racial/ethnic differences in unhealthy sleep duration.
Design:
Data from the 2004-2013 National Health Interview Survey were analyzed using SPSS 20.
Setting:
Data were collected through personal household interviews in the United States.
Participants:
Of the total 261,686 participants (age ≥ 18 years), 17.0% were black, 83.0% were white; and mean age was 48 years (SE=0.04).
Measurements:
To ascertain total sleep duration, participants were asked “how many hours of sleep do you get on average in a 24-hour period?” Sleep duration was coded as short sleep (<7hrs), average sleep (7-8hrs), or long sleep (>8hrs). Emotional Distress—feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period---was measured by Kessler-6, a six item screening scale.
Results:
Of participants reporting significant emotional distress (4.0% black , 3.5% white) Chi-square analyses revealed higher percentage of blacks compared with whites reported unhealthy sleep durations, and greater a percentage of whites reported average sleep duration (7-8 hrs.). Blacks had increased prevalence of short (PR = 1.32, p < 0.001) or long (OR = 1.189, p < 0.001) sleep, compared with whites. The interaction between race/ethnicity and emotional distress was significantly associated with short (PR=0.99, p<.001) and long sleep (OR=0.98, p<.001) durations.
Conclusions:
Being black and reporting greater levels of emotional distress are significant predictors of short and long sleep durations. Emotional distress might partially explain racial/ethnic differences in unhealthy sleep duration between blacks and whites.
Keywords: emotional distress, sleep duration, race
Introduction
The increasing prevalence of unhealthy sleep duration, defined as short (<7hrs/day) or long (>8 hrs./day) sleep durations, is a serious public health challenge in the U.S. as it is accompanied by increased risk of cardiovascular, cardiometabolic disease and allcause mortality rates.1–4 Evidence shows that unhealthy sleep duration is more prevalent among blacks compared with whites5 and has been linked to increased cardiovascular and cerebrovascular risk, metabolic disorders, and diminished mental health functioning.6,7 While the negative health consequences of unhealthy sleep are well-documented, there are limited data on potential determinants of unhealthy sleep duration, especially among blacks in the U.S. who have a higher prevalence of short and long sleep duration compared to whites.1 Differences in sleep duration between blacks and whites have been attributed to: a) biological factors8,9 b) behavioral factors10; c) environmental factors11,12; d) psychosocial factors13–15; and e) medical conditions16,17. Of the five domains, psychosocial factors are generally considered the most proximal, easiest to modify, and therefore a potential solution to improve overall sleep quantity and quality among blacks.
Prior studies have provided initial evidence that certain psychosocial factors, such as lower income, unemployment, and limited access to social resources (all psychosocial factors) among blacks may explain the development and maintenance of unhealthy sleep.15,18 However, there is little population-based evidence regarding the impact of emotional distress on sleep duration and whether it might explain racial/ethnic disparity in unhealthy sleep durations. Emotional distress is defined as a state of emotional suffering characterized by symptoms of depression (e.g. lost interest, sadness, and hopelessness) and anxiety (e.g. restlessness and feeling tense19, which can affect overall health and well-being.18 In fact, the often unrecognized and under-analyzed interaction between emotional distress and socio-demographic factors, such as low socioeconomic status may be masking the independent effect of emotional distress on sleep. In light of the foregoing evidence, the aim of the current paper was to explore whether emotional distress might explain racial/ethnic disparity in unhealthy sleep durations.
Participants and Methods
Participants
The study utilized data from the 2004-2013 National Health Interview Survey (NHIS). A total sample of 261,686 participants (blacks and whites) provided data for all analyses. Of the total sample, 17.0% were black and 83.0% were white. The mean age was 48 years (SE=0.04). Participants were administered questionnaires to obtain demographic, socioeconomic, and medical data. NHIS sampling weights were applied in all analyses to ensure the sample reflected the US population across the specific ages and to control for oversampling. For the current paper, analyses included adults aged ≥ 18 with complete data on all target variables.
Measures
To ascertain total sleep duration, participants were asked “how many hours of sleep do you get on average in a 24-hour period?” Sleep duration was coded as short sleep (<7hrs), average sleep (7-8hrs), or long sleep (>8hrs)15. Emotional Distress (ED)—feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period---was measured by Kessler-6, a six item screening scale. Scores ranged from 0-24, and higher scores indicate greater levels of anxiety and depressive symptoms20. In our regression analyses, we coded Kessler-6 continuously because the mean emotional distress score was 2.54 (Standard Error=0.01) and the majority of the sample had a score less than 13 and not emotionally distressed. Treating Kessler-6 as a continuous variable accounts for more variance and increases the likelihood of detecting small effects on sleep duration.
Covariates
Possible confounding variables were identified and were included as covariates. Patient characteristics such as age, sex, BMI, marital status, alcohol use, tobacco use, and family income were based on patient self-report. Age and BMI were used as continuous covariates while all other variables were coded dichotomously: marital status (married/un-married), alcohol use (currently using/not currently using), tobacco use (currently using/not currently using), family income (less than $35,000 per year/ more than $35,000 per year), employment (employed/unemployed), education (less than high school/greater than high school), and poverty status (below poverty line/above poverty line). Comorbidities (Hypertension, CHD, Heart Condition, Diabetes and Cancer) were assessed by participant self-report of ever being diagnosed by a physician with the condition.
Data Analysis
Chi-square analysis was performed between demographic and target variables—emotional distress and short, average and long sleep durations (See Table 1). We performed Poisson regression analysis to determine whether emotional distress was independently associated with short or long sleep durations in blacks and whites, adjusting for sociodemographic factors (marital status, family income, employment, education and poverty status), health risk behaviors (smoking and alcohol drinking), and chronic diseases (hypertension, heart disease, heart conditions, diabetes and cancer). Other covariates also included age, body mass index (BMI), and gender. All models were standardized and harmonized for the complex sample design of NHIS and adjusted for differences in NHIS sample design between 2004-2005 and 2006-2013.Rao-Scott corrections for Chi-squared tests were also performed.
Primary analyses utilized Poisson regressions to calculate prevalence rates of Short and Long Sleep relative to Normal Sleep. Four models were evaluated in the primary analyses. Model 1 was unadjusted. Model 2 was age/sex adjusted, Model 3 was adjusted for other patient characteristics (such as BMI, marital status, and SES), and Model 4 was adjusted for medical comorbidities.
The interaction between emotional distress and race was coded so that interaction effect reflects the increase in prevalence of short and long sleep for a one unit increase on the Kessler-6 for a black participant, compared to their white counterparts.
Missing data for covariates were dealt with by multiple imputations of 5 datasets using full conditional specification (FCS). All analyses were conducted using SPSS version 22 and R version 3.3.0.The analysis packages “survey” and “mitools” were used to deal with the complex sample design of NHIS and to create pooled estimates of results from the primary analyses.21–23
Results
Descriptive statistics
Of the total sample, 17.0% were black and 83.0% were white. The total sample mean score for emotional distress was 2.5 (SE=0.01). Of the total sample, 2.7% were very short sleepers, 26.82% short sleepers, 61.59 % were average sleepers, and 8.9% were long sleepers. Blacks (4.0%) had a higher prevalence of significant emotional distress, compared with whites (3.5%). Other variables analyzed included age (mean of 48, SE=0.04), married (45.1%) and obese--body mass index > 30 kg/m2-- (27.1%). Black race/ethnicity and emotional distress were significant predictors of short and long sleep durations. Chi-square analysis revealed that 36.6% of blacks reported short sleep duration, 9.7% reported long sleep duration, and 53.7% reported average sleep duration. Of the sub-sample of individuals with clinical distress, 53.0% reported short sleep duration, 14.9% reported long sleep duration, and 32.1% reported average sleep duration (See Table 1).
Inferential Statistics
Based on the covariate adjusted Poisson regression analysis, blacks have a 32% increased prevalence of reporting short sleep (PR = 1.32, 95% CI = 1.29-1.35, p < 0.001) and 18% increased prevalence of reporting long sleep (PR = 1.18, 95% CI=1.13-1.23= p < 0.001) compared with whites (See Table 2, Model 3). Each unit increase in emotional distress increases the prevalence short sleep by 5% (PR = 1.05, 95% CI = 1.05-1.06, p < 0.001) and the prevalence of long sleep by 5% (PR = 1.05, 95% CI 1.05-1.05, p < 0.001) (See Table 2, Model 4). Most importantly, there appears to be a significant interaction effect between race and emotional distress on sleep duration. Results indicate that blacks with higher emotional distress scores had 1% lower prevalence of short sleep duration (OR=0.99, 95% CI =0.98-0.99, p<.001; and 2% lower prevalence of long sleep duration (OR=0.98, 95% CI = 0.97-0.99, p<.001) compared to their white counterparts (See Table 2, Model 4).
The effects of emotional distress, race, and the significant race by emotional distress interaction persist even when the sample is stratified by gender (Tables 3 and 4). Furthermore, emotional distress is significantly associated with both short and long sleep duration when the sample is stratified by race (Tables 5 and 6).
Discussion
The current study explored whether emotional distress might explain differences in short and long sleep durations between blacks and whites. Blacks had higher rates of short and long sleep durations compared to whites, which is consistent with previous findings.5 Additionally, blacks with higher emotional distress were more likely to report short or long sleep durations compared to their white counterparts. These findings suggest that blacks’ sleep duration regardless of gender effects is more affected by emotional distress compared to whites. Previous studies attribute racial/ethnic sleep differences to: 1) biological (such as blacks having shorter circadian rhythms compared to whites);8,9 2) behavioral (such as smoking, diet, and physical activity);10 3) environmental (such as neighborhood disadvantage and black carbon);11,12 4) psychosocial (such as increased occupational responsibility and shiftwork);13,14,24 and medical comorbidities (such as obesity, Type 2 diabetes, and sleep apnea)16,17 factors. However, our findings make a significant contribution to the literature by suggesting that emotional distress, a more proximal and modifiable psychosocial factor, may explain differences in unhealthy, short or long, sleep duration between blacks and whites.
Emotional/Psychological Distress among Blacks
Our finding that blacks reported greater levels of emotional distress compared to whites is consistent with previous epidemiological studies and recent reports from the U.S. Department of Health and Human Services Office of Minority Health and the Centers for Disease Control and Prevention.4 These documents report that emotional distress among blacks was more likely if the individual was below the federal poverty line, uninsured, had obstructive pulmonary disease, diabetes, or heart diseases. Other studies indicate that racial/ethnic minorities who disproportionately experience life stressors, such as racial discrimination, job loss, unemployment, and family/work-related conflict, were more susceptible to emotional/psychological distress and chronic diseases.25–28 As evidenced in the current study, emotional distress compared to sociodemographic, behavioral, and chronic disease factors was more predictive of short sleep duration and long sleep duration for both blacks and whites. However, blacks compared to whites had a higher prevalence of emotional distress, short sleep and long sleep durations, and appeared to be more affected by the ill effects of emotional distress on sleep duration compared to whites.
Short Sleep and Long Sleep durations among Blacks
Previous studies have indicated a host of biological, environmental, health, medical comorbidities, and psychosocial factors that might explain differences in sleep duration between blacks and whites. First, studies have shown that blacks and whites have different circadian biological clocks, as evidenced by the shorter circadian rhythms (free running circadian periods) among blacks compared to whites.9 Differences in circadian rhythm may have negative effects on sleep duration and may explain why blacks report greater levels of short and long sleep durations.9,29 Second, environmental factors such as nocturnal environmental noise, lack of air conditioning and heating, and air pollution30,31 which disproportionately affect urban blacks, can disrupt an individual’s sleep duration, quality, and architecture and might explain racial/ethnic differences in sleep duration.11,32,33 Recent findings indicate that changes 6-17 year olds in the National Survey of Children’s Health, children from neighborhoods with low socioeconomic status, high levels of social disadvantage, safety concerns, poor housing, garbage/litter, vandalism, sidewalks, and little parks/playgrounds, were more likely to report sleep disruption.34 Additionally, children who were less physically active and exposed to high levels of secondhand smoking reported sleep problems. Third, medical conditions, such as cancer, chronic pain, diabetes, cardiovascular disease, mental health, and respiratory, gastrointestinal and urinary issues, are associated with restricted and prolonged sleep durations and might explain racial/ethnic differences in sleep duration.35 Fourth, psychosocial factors like socioeconomic status (low education and unemployed), low income, and being unmarried are another cluster of factors that might explain racial/ethnic differences in sleep duration.10
Despite the plethora of potential determinants of racial/ethnic differences in sleep duration disruptions, to our knowledge, very few studies have found which determinants significantly lead to sleep differences between blacks and whites. We found that having controlled for sociodemographic, behavioral, chronic diseases, and health risk behaviors, emotional distress was independently associated with short and long sleep durations among blacks, and may partially explain racial/ethnic differences in short and long sleep durations.
Blacks compared to whites disproportionately encounter high levels of prejudice and discrimination, which may lead to higher levels of emotional distress. Tomfohr, Pung, Edwards and Dimsdale36 found that discrimination among blacks was linked to disruption in sleep architecture, such as less slow-wave sleep. Based on Tomfohr and colleagues findings, blacks spend more time in light sleep and less time in deep sleep, which may result in disruption of total sleep time and increases likelihood of unhealthy sleep (short or long sleep durations). Furthermore, chronic exposure to discrimination may lead to emotional distress among blacks, which in turn may induce hypothalamic-pituitary-adrenal (HPA) axis dysfunction and sympathetic nervous system (SNS) hyperactivation and disruption in sleep architecture.37
Implications of our findings go beyond explaining differences in short and long sleep durations between blacks and whites. In fact, our findings provide a potentially novel mechanism explaining observed racial disparities in cardiovascular disease and unhealthy metabolic conditions between blacks and whites via emotional distress and unhealthy sleep (short and long sleep).2,38
Limitations and Future directions
Findings from the current paper should be interpreted cautiously in light of several potential limitations. First, the use of self-report sleep duration, as opposed to objective measurement of sleep from polysomnography, may not yield the most accurate measurement of an individual’s typical sleep duration. Second, the cross-sectional design of the NHIS study prohibits us from making causal inferences between emotional distress and sleep duration. Third, the measurement of sleep duration is misleading because it assumes that sleep duration reported represents average sleep pattern in weekdays and weeknights, which studies have shown can be significantly different. Fourth, we were unable to determine the nature and source of emotional distress, and therefore unable to distinguish if reported emotional distress was due to the presence of a mental illness or general psychosocial stress. Fourth, there may be self-reporting error of sleep duration by race as well as the possibility of unmeasured and residual confounding effects. Future studies should investigate whether significant reductions in emotional distress might improve overall sleep quality among blacks, and therefore reduce differences in sleep duration between blacks and whites. Additionally, future studies should include other emotionally distressing symptoms beyond depressive and anxiety symptoms. Lastly, future work should investigate other modifiable factors that might explain racial/ethnic differences in unhealthy sleep duration.
Conclusion
Despite the foregoing limitations, our study adds significantly to the literature by suggesting that emotional distress may provide insights about sleep disparities between blacks and whites. Short sleep and long sleep durations are important public health problems in the United States, especially among blacks who are disproportionately affected. Although sleep duration is influenced by biological, environmental, medical, and sociodemographic factors, our finding that emotional distress may contribute to observed racial/ethnic differences in sleep duration presents opportunities to intervene and eliminate and reduce racial/ethnic differences in unhealthy sleep. Our study revealed that blacks with emotional distress, even at lower levels, are at significant risk of short sleep or long sleep, which might contribute to observed racial/ethnic differences in certain chronic medical conditions.
Acknowledgments
This work was supported by funding from the NIH (R01MD007716) and the NINDS (U54NS081765). However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
APPENDICES
Table 1.
Characteristics of study participants across different sleep durations (N=261,686).
| Variable | Total Sample (N=261,686) | Short Sleep (N=77,306) | Average Sleep (N=161,170) | Long Sleep (N=23,210) | p-value |
|---|---|---|---|---|---|
| Black | 44,426 (17.0%) | 16,254 (21.0%) | 23,845 (14.8%) | 4,327 (18.6%) | <.001 |
| Emotional Distress | 2.54 (0.01) | 3.55 (0.02) | 1.94 (0.01) | 3.28 (0.03) | <.001 |
| Clinically Significant Distress | 9,438 (3.6%) | 5,001 (6.5%) | 3,033 (1.9%) | 1,404 (6.0%) | <.001 |
| Age (years) | 47.97 (0.04) | 47.32 (0.06) | 47.62 (0.05) | 52.64 (0.14) | <.001 |
| Female | 146,289 (55.9%) | 43,369 (56.1%) | 89,209 (55.4%) | 13,711 (59.1%) | <.001 |
| Body Mass Index (BMI) kg/m2 | 27.38 (0.01) | 28.00 (0.02) | 27.09 (0.01) | 27.41 (0.04) | <.001 |
| Married | 118,054 (45.1%) | 32,122 (41.6%) | 76,822 (47.7%) | 9,109 (39.2%) | <.001 |
| Current Smoker | 52,366 (20.1%) | 19,191 (24.8%) | 28,196 (17.5%) | 4,979 (21.5%) | <.001 |
| Current Drinker | 163,079 (62.3%) | 49,308 (63.8%) | 101,814 (63.2%) | 11,957 (51.5%) | <.001 |
| Family Income Less Than $35,000 | 117,432 (44.9%) | 36,220 (46.9%) | 67,692 (42.0%) | 13,519 (58.2%) | <.001 |
| Employed | 156,683 (59.9%) | 48,569 (62.8%) | 100,291 (62.2%) | 7,823 (33.7%) | <.001 |
| Less than High School Education | 46,031 (17.6%) | 13,281 (17.2%) | 26,632 (16.5%) | 6,118 (26.4%) | <.001 |
| Below the Poverty Line | 45,597 (17.4%) | 14,809 (19.2%) | 25,194 (15.6%) | 5,594 (24.1%) | <001 |
| Hypertension Diagnosis | 81,803 (31.3%) | 26,461 (34.2%) | 46,017 (28,6%) | 9,325 (40.2%) | <.001 |
| CHD Diagnosis | 13,192 (5.0%) | 4,181 (5.4%) | 6,987 (4.3%) | 2,024 (8.7%) | <.001 |
| Heart Problems | 20,881 (8.0%) | 6,862 (8.9%) | 11,182 (6.9%) | 2,837 (12.2%) | <.001 |
| Diabetes Diagnosis | 25,101 (9.6%) | 8,264 (10.7%) | 13,432 (8.3%) | 3,405 (14.7%) | <.001 |
| Cancer Diagnosis | 22,376 (8.6%) | 6,541 (8.5%) | 12,915 (8.0%) | 2,920 (12.6%) | <.001 |
Table 2.
Multinomial Logistic Regression Models: associations between emotional distress, race/ethnicity, and sleep duration.
|
Model 1: Unadjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.30 (1.28-1.33) | 1.24 (1.19-1.28) | |
|
Model 1a: Unadjusted w/Interaction |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.08-1.08) | |
| White | REF | REF | |
| Black | 1.37 (1.34-1.40) | 1.32 (1.27-1.38) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 2: Age/Sex Adjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.08-1.08) | |
| White | REF | REF | |
| Black | 1.37 (1.34-1.40) | 1.39 (1.34-1.45) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 3: Adjusted for Patient Characteristics |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.05-1.06) | 1.05 (1.05-1.06) | |
| White | REF | REF | |
| Black | 1.32 (1.29-1.35) | 1.18 (1.13-1.23) | |
| Emotional Distress by White Race Interaction | REF | REF | |
| Emotional Distress by Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (097-0.99) | |
|
Model 4: Adjusted for comorbidity |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.05-1.06) | 1.05 (1.05-1.05) | |
| White | REF | REF | |
| Black | 1.32 (1.29-1.35) | 1.18 (1.13-1.23) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) |
Model 1- Unadjusted
Model 2- Adjusted for age and sex
Model 3- Model 2 covariates plus BMI, Marital Status, Current Smoking Status, Current Drinking Status, Family Income, Employment, Education and Poverty Status
Model 4- Model 3 covariates plus Hypertension Diagnosis, CHD Diagnosis, Heart Problems, Cancer Diagnosis, and Diabetes Diagnosis
All Findings: p-value<.001
Table 3.
Multinomial Logistic Regression Models: associations between emotional distress, race/ethnicity, and sleep duration (MALES)
|
Model 1: Unadjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.05-1.06) | 1.08 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.32 (1.28-1.35) | 1.28 (1.21-1.36) | |
|
Model 1a: Unadjusted w/Interaction |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.38 (1.33-1.43) | 1.35 (1.26-1.45) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.98 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 2: Age/Sex Adjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.08-1.09) | |
| White | REF | REF | |
| Black | 1.37 (1.32-1.42) | 1.44 (1.34-1.53) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.98 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 3: Adjusted for Patient Characteristics |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.05-1.06) | 1.05 (1.04-1.05) | |
| White | REF | REF | |
| Black | 1.38 (1.33-1.42) | 1.16 (1.08-1.24) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.98 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 4: Adjusted for comorbidity |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.05-1.06) | 1.04 (1.04-1.05) | |
| White | REF | REF | |
| Black | 1.37 (1.32-1.42) | 1.16 (1.08-1.24) | |
| Emotional Distress x White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.98 (0.98-0.99) | 0.98 (0.97-0.99) |
Model 1- Unadjusted
Model 2- Adjusted for age and sex
Model 3- Model 2 covariates plus BMI, Marital Status, Current Smoking Status, Current Drinking Status, Family Income, Employment, Education and Poverty Status
Model 4- Model 3 covariates plus Hypertension Diagnosis, CHD Diagnosis, Heart Problems, Cancer Diagnosis, and Diabetes Diagnosis
All Findings: p-value<.001
Table 4.
Multinomial Logistic Regression Models: associations between emotional distress, race/ethnicity and sleep duration (FEMALES)
|
Model 1: Unadjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.07 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.30 (1.27-1.33) | 1.20 (1.15-1.25) | |
|
Model 1a: Unadjusted w/Interaction |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.37 (1.34-1.41) | 1.29 (1.23-1.35) | |
| Emotional Distress by White Race Interaction | REF | REF | |
| Emotional Distress by Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 2: Age/Sex Adjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.07-1.08) | |
| White | REF | REF | |
| Black | 1.38 (1.34-1.42) | 1.36 (1.30-1.43) | |
| Emotional Distress by White Race Interaction | REF | REF | |
| Emotional Distress by Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) | |
|
Model 3: Adjusted for Patient Characteristics |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.05-1.06) | 1.06 (1.05-1.06) | |
| White | REF | REF | |
| Black | 1.29 (1.25-1.33) | 1.17 (1.11-1.23) | |
| Emotional Distress by White Race Interaction | REF | REF | |
| Emotional Distress x Black Race Interaction | 0.99 (0.99-0.99) | 0.98 (0.97-0.99) | |
|
Model 4: Adjusted for comorbidity |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.05-1.05) | 1.05 (1.05-1.06) | |
| White | REF | REF | |
| Black | 1.29 (1.25-1.33) | 1.17 (1.11-1.23) | |
| Emotional Distress by White Race Interaction | REF | REF | |
| Emotional Distress by Black Race Interaction | 0.99 (0.98-0.99) | 0.98 (0.97-0.99) |
Model 1- Unadjusted
Model 2- Adjusted for age and sex
Model 3- Model 2 covariates plus BMI, Marital Status, Current Smoking Status, Current Drinking Status, Family Income, Employment, Education and Poverty Status
Model 4- Model 3 covariates plus Hypertension Diagnosis, CHD Diagnosis, Heart Problems, Cancer Diagnosis, and Diabetes Diagnosis
All Findings: p-value<.001
Table 5.
Multinomial Logistic Regression Models: associations between emotional distress and sleep duration (BLACKS)
|
Model 1: Unadjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.04 (1.04-1.05) | 1.06 (1.05-1.06) | |
|
Model 2: Age/Sex Adjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.04 (1.04-1.05) | 1.06 (1.05-1.06) | |
|
Model 3: Adjusted for Patient Characteristics |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.04-1.05) | 1.03 (1.03-1.04) | |
|
Model 4: Adjusted for comorbidity |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.04-1.05) | 1.03 (1.02-1.04) |
Model 1- Unadjusted
Model 2- Adjusted for age and sex
Model 3- Model 2 covariates plus BMI, Marital Status, Current Smoking Status, Current Drinking Status, Family Income, Employment, Education and Poverty Status
Model 4- Model 3 covariates plus Hypertension Diagnosis, CHD Diagnosis, Heart Problems, Cancer Diagnosis, and Diabetes Diagnosis
All Findings: p-value<.001
Table 6.
Multinomial Logistic Regression Models: associations between emotional distress and sleep duration (WHITES)
|
Model 1: Unadjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.08-1.08) | |
|
Model 2: Age/Sex Adjusted |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.06 (1.06-1.06) | 1.08 (1.08-1.08) | |
|
Model 3: Adjusted for Patient Characteristics |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.05-1.06) | 1.05 (1.05-1.06) | |
|
Model 4: Adjusted for comorbidity |
Variable | Short Sleep | Long Sleep |
| OR (95% CI) | OR (95% CI) | ||
| Emotional Distress | 1.05 (1.05-1.05) | 1.05 (1.05-1.05) |
Model 1- Unadjusted
Model 2- Adjusted for age and sex
Model 3- Model 2 covariates plus BMI, Marital Status, Current Smoking Status, Current Drinking Status, Family Income, Employment, Education and Poverty Status
Model 4- Model 3 covariates plus Hypertension Diagnosis, CHD Diagnosis, Heart Problems, Cancer Diagnosis, and Diabetes Diagnosis
All Findings: p-value<.001
Footnotes
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