Exploring Features of the Physical Environment as Contributors to Racial and Ethnic Disparities in Sleep Duration and Efficiency among Older Adults.

Abstract

Study objectives: Racial and ethnic sleep disparities have been documented; however, the mechanisms are unclear. In a cross-sectional analysis, we examined the contribution of features of the physical environment to sleep disparities among Black, Chinese, Hispanic, and White adults (N=1945, average age:68.5+9.1).

Methods: Physical environment measures were self-reported (aesthetic quality, walking environment) and objectively-measured via Geographic Information Systems (walking destination density, proportion of land dedicated to retail space, overall built environment score). Sleep duration (short:<6 hours) and sleep efficiency were measured via 7-day actigraphy. Multi-level linear and Poisson regression models with robust variance were fit to examine associations with adjustment for covariates. Direct and indirect mediation was tested via path models.

Results: Insufficient sleep was highest for minoritized individuals (short sleep: 32.5-44.1%, <85% sleep efficiency: 9.3-10.5%). Living in neighborhoods with higher aesthetic quality scores was associated with sleeping 5.8 minutes (0.67, 10.85) longer on average. Higher walking destination density, proportion retail, and built environment scores were associated with shorter sleep duration and higher prevalence of short sleep (adjusted prevalence ratio: 1.0001 [1.0005,1.0016], 1.02 [1.01,1.04], and 1.06 [1.02,1.09], respectively). Proportion retail partially explained the Black-White (2.8%) and Chinese-White (11.3%) difference in sleep duration. The Hispanic-White difference in sleep duration was partially (5.8-26.5%) explained by differences in aesthetic quality, walking destination density, proportion retail, and built environment score. There were no associations between features of the physical environment and sleep efficiency.

Conclusions: Features of the physical environment partially contributed to racial disparities in sleep duration and is a likely target for intervention.