Social and Environmental Determinants of Health Equity

National Institute Of Environmental Health Sciences

Investigators

Linked publications & trials

Abstract

Growing evidence suggests that sleep contributes to the incidence and severity of cardiometabolic conditions (e.g., obesity, hypertension, diabetes, cardiovascular disease). My objective is to investigate how physical and social environmental determinants impact racial, ethnic, and socioeconomic disparities in the relationship between sleep and cardiometabolic health. Determinants of Sleep and Chronic Disease In the past, colleagues and I have investigated associations between sleep and health conditions like obesity, type 2 diabetes (T2DM), and cardiovascular disease (CVD). We have shown that sleep disturbances are prevalent among middle-aged and older adults, and vary by race/ethnicity, sex, and obesity status. We have also shown that the high prevalence of sleep disturbances and undiagnosed sleep apnea among racial/ethnic minorities may contribute to health disparities (Chen et al, 2015; Chen et al, 2016; Jackson et al, 2015). Because of my strong interest in obesity independent of its relationship with sleep, I have also studied racial/ethnic disparities in obesity trends by socioeconomic status (Jackson et al, 2016; Jackson et al, 2013) as well as dietary (Jackson et al, 2015; Jackson et al, 2014) and body mass index (Tobias et al, 2014; Global BMI Collaboration, 2016; Jackson et al, 2014; Jackson et al, 2014; Jackson et al, 2014) influences on health and mortality. Colleagues and I have reported (FY 2017 October 2016-2017) a U-shaped relationship between sleep duration and risk of type 2 diabetes with the lowest type 2 diabetes risk at 7-8 hours per day of sleep duration (Shan et al, 2016). We have also reported that sleeping difficulty is associated with an increased risk of T2DM, independent of other CVD risk factors (Li et al, 2016). I am now using data from the NIEHS Sisters Study, Multi-Ethnic Study of Atherosclerosis (MESA), and the Jackson Heart Study to investigate determinants of racial/ethnic and socioeconomic disparities in sleep health and subsequent risk of cardiometabolic dysfunction. In fact, we published a MESA study with the objective of identifying systematic biases across groups in objectively and subjectively measured sleep duration. We found that self-reported sleep duration overestimated objectively measured sleep across all races. Compared with PSG, overestimation was significantly greater in whites compared with blacks. This is noteworthy because larger reporting bias reduces the ability to identify significant associations between sleep duration and health across racial groups. Therefore, sleep measurement property differences should be considered when comparing sleep indices across racial/ethnic groups. We also investigated the association between multiple sleep dimensions and chronic kidney disease using MESA data. Among the 1895 White, Black, Hispanic/Latino, and Asian participants, we found that very short sleep and sleep apnea associated hypoxia were both associated with a higher prevalence of CKD, which highlights the potential role for novel interventions (Jackson et al, 2020). In 2021, we investigated the relationship between racial/ethnic discrimination and type 2 diabetes mellitus risk using data from the Sister Study (Gaston et al. 2021). Among 33,000 White, Black and Hispanic/Latina women, we found that three in four Black women and one in three Hispanic/Latina women reported everyday discrimination. We also found that experiencing major discrimination was marginally associated with higher type II diabetes mellitus risk. Anti-discrimination efforts may help mitigate racial/ethnic disparities in T2DM risk. In a separate study, we found that nightly swine odor was associated with lower nightly sleep duration and that hydrogen sulfide detection was associated with more sleep awakenings, which underscores the importance of emissions reduction and odor abatement as public health goals when designing technology solutions to waste management (MacNell et al. 2021). I was also an author of a commentary developed as a result of a virtual workshop hosted by the National Academies of Sciences, Engineering, and Medicine in June 2020. The commentary focused on integrating the science of aging and environmental health research using an Exposome approach (Nwanaji-Enwerem et al. 2021). Because of a strong interest in identifying upstream environmental factors that contribute to sleep health disparities, I am also developing a mixed methods project to investigate the work-sleep relationship by race and am studying the impact of factors in the physical environment like housing conditions that may contribute to disparities in sleep. Since starting at NIEHS in January 2017, my research findings have been presented at several sleep-related and epidemiological scientific conferences, including the Joint Meeting of the American Academy of Sleep Medicine and the Sleep Research Society as well as the Society for Epidemiologic Research.