Social and Environmental Determinants of Health Equity

National Institute Of Environmental Health Sciences

Investigators

Linked publications, trials & patents

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), hypertension, 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. I mainly use data from the NIEHS Sisters Study, Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study, and the National Health Interview Survey to investigate determinants of racial/ethnic and socioeconomic disparities in sleep health and subsequent risk of cardiometabolic dysfunction. 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). Colleagues and I have reported (FY 2021 October 2020-2022), that self-reported sleep duration overestimated objectively measured sleep across all races (Jackson et al. 2022). Compared with PSG, overestimation was significantly greater in whites compared with blacks, which was 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 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 2022, my research group and I published data from the African American Sleep & Health (AASH) Study, which was a community-based, cross-sectional study using a convergent parallel mixed methods approach to determine the relationship between greenspace redevelopment, social environmental stressors associated with the pressure of displacement, and sleep health among Black adults in Southwest Atlanta, Georgia (Williams et al. 2022). This was an important investigation because greenspace redevelopment can reproduce the conditions that drive inequities in sleep health. We found among all participants, everyday discrimination and heightened vigilance were associated with an increase in subjective sleep disturbances. The associations between financial strain, subjective sleep duration, and objective sleep efficiency were moderated by exposure to GR with exposed participants experiencing high vs. no financial strain having shorter subjective duration and lower objective sleep efficiency. We also used data from survey years 2013 to 2018 of the National Health Interview Survey to investigate neighborhood social cohesion and serious psychological distress among Asian, Non-Hispanic (NH)-Black, Hispanic/Latinx, and NH-White men as well as women in the United States (N=168,573). (Gullett et al. 2022). We found that NH-Black, Hispanic/Latinx, and participants with lower household incomes were disproportionately represented among those who reported low nSC while Hispanic/Latinx participants, women, and lower income participants were overrepresented among those with SPD. Overall, participants who perceived their neighborhoods as having low vs. high social cohesion were more likely to report SPD, which was consistent with our hypotheses. These findings underscore the importance of examining nSC and other upstream determinants of SPD through an intersectional lens in the overall population, which can inform future neighborhood-level interventions and policies designed to improve mental health and address health disparities. Using a large, nationally representative database from the 2006 to 2017 National Inpatient Sample with interest in eventually addressing sleep disorders, colleagues and I estimated the prevalence and trends of insomnia among pregnant women over a 12-year period (Salemi et al. 2022). In addition, we examined the interplay among insomnia, maternal comorbidities, and severe maternal morbidity (SMM). Overall, we found in the largest study conducted on this topic with clinically-diagnosed insomnia to date that rates of a coded diagnosis of insomnia increased throughout the study period in both delivery and non-delivery hospitalizations. Rates of insomnia also increased with maternal age. We observed a strong association between insomnia and nearly all of the obstetric comorbidities identified in the study, and even after controlling for the overall obstetric comorbidity burden, found that the diagnosis of insomnia is an independent predictor of SMM at delivery. 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 American Thoracic Society, the Sleep Research Society, as well as the Society for Epidemiologic Research.