Table 3. Association of sleep duration at age 50 with transitions from a healthy state to first chronic disease, multimorbidity, and mortality (N = 7,217).

Sleep duration at 50y	N cases/N total	Model 1: Unadjusted model (age as timescale)		Model 2: Adjusted for sociodemographic variablesa		Model 3: Model 2 + behavioral and health-related factorsb
		HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
Healthy to first chronic disease c , transition A (N cases/N total = 4,446/7,217; mean age at event (SD) = 66.2 (8.5) years)
≤5 hours	319/474	1.31 (1.16, 1.47)	<0.001	1.28 (1.14, 1.44)	<0.001	1.20 (1.06, 1.35)	0.003
6 hours	1,428/2,350	1.07 (1.00, 1.14)	0.059	1.06 (0.99, 1.13)	0.097	1.03 (0.96, 1.10)	0.418
7 hours	2,038/3,323	1.00 (ref)		1.00 (ref)		1.00 (ref)
8 hours	621/1,008	1.00 (0.91, 1.09)	0.944	0.99 (0.90, 1.08)	0.745	0.98 (0.90, 1.08)	0.730
≥9 hours	40/62	1.16 (0.84, 1.58)	0.367	1.10 (0.80, 1.50)	0.558	1.10 (0.80, 1.50)	0.571
Healthy to death, transition B (N cases/N total = 213/7,217; mean age at event (SD) = 65.2 (9.0) years)
≤5 hours	14/474	1.24 (0.71, 2.18)	0.447	1.12 (0.64, 1.97)	0.689	0.97 (0.55, 1.72)	0.926
6 hours	71/2,350	1.17 (0.86, 1.59)	0.314	1.12 (0.82, 1.52)	0.465	1.06 (0.78, 1.44)	0.727
7 hours	98/3,323	1.00 (ref)		1.00 (ref)		1.00 (ref)
8 hours	29/1,008	0.97 (0.64, 1.47)	0.902	0.96 (0.63, 1.45)	0.829	0.96 (0.63, 1.45)	0.844
≥9 hours	1/62	na		na		na
First chronic diseasec to multimorbidityc, transition C (N cases/N total = 2,297/4,446; mean age at event (SD) = 71.9 (7.2) years)
≤5 hours	183/319	1.34 (1.15, 1.57)	0.000	1.27 (1.09, 1.50)	0.003	1.21 (1.03, 1.42)	0.021
6 hours	739/1,428	1.13 (1.02, 1.24)	0.014	1.12 (1.02, 1.23)	0.019	1.10 (1.00, 1.21)	0.041
7 hours	1,042/2,038	1.00 (ref)		1.00 (ref)		1.00 (ref)
8 hours	310/621	0.98 (0.86, 1.11)	0.768	0.98 (0.86, 1.11)	0.767	0.98 (0.86, 1.11)	0.771
≥9 hours	23/40	1.29 (0.85, 1.95)	0.226	1.18 (0.77, 1.79)	0.451	1.10 (0.72, 1.68)	0.661
First chronic diseasec to death, transition D (N cases/N total = 474/4,446; mean age at event (SD) = 68.9 (7.9) years)
≤5 hours	32/319	1.17 (0.80, 1.69)	0.422	1.16 (0.79, 1.69)	0.454	1.19 (0.81, 1.74)	0.374
6 hours	163/1,428	1.27 (1.03, 1.56)	0.023	1.27 (1.04, 1.57)	0.022	1.30 (1.06, 1.60)	0.013
7 hours	205/2,038	1.00 (ref)		1.00 (ref)		1.00 (ref)
8 hours	69/621	1.09 (0.83, 1.43)	0.543	1.09 (0.83, 1.44)	0.516	1.10 (0.83, 1.44)	0.509
≥9 hours	5/40	na		na		na
Multimorbidityc to death, transition E (N cases/N total = 787/2,297; mean age at event (SD) = 76.0 (6.8) years)
≤5 hours	65/183	1.04 (0.79, 1.35)	0.788	1.07 (0.82, 1.40)	0.636	1.07 (0.81, 1.40)	0.631
6 hours	254/739	1.09 (0.93, 1.28)	0.290	1.10 (0.94, 1.30)	0.236	1.10 (0.94, 1.30)	0.236
7 hours	348/1,042	1.00 (ref)		1.00 (ref)		1.00 (ref)
8 hours	112/310	1.06 (0.85, 1.31)	0.613	1.08 (0.87, 1.34)	0.462	1.09 (0.88, 1.35)	0.420
≥9 hours	8/23	0.93 (0.46, 1.88)	0.843	1.10 (0.54, 2.24)	0.785	1.09 (0.54, 2.22)	0.808

^a Adjusted for age (timescale), sex, ethnicity, education, occupational position, and marital status.

^b Additionally adjusted for alcohol consumption, physical activity, smoking status, fruit and vegetable consumption, BMI, hypertension, and use of sleep medication.

^c Chronic disease among diabetes, cancer, coronary heart disease, stroke, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, depression, dementia, other mental disorder, Parkinson’s disease, and arthritis/rheumatoid arthritis; multimorbidity defined as 2 or more of these diseases.

For transitions see Fig 1.

CI, confidence intervals; HR, hazard ratio; na, not applicable (N cases ≤5); ref, reference; SD, standard deviation.