title: Geographic variations in sleep duration: a multilevel analysis from the Boston Area Community Health (BACH) Survey.
abstract: BACKGROUND
  Sleep plays an important role in health and varies by social determinants. Little is known, however, about geographic variations in sleep and the role of individual-level and neighbourhood-level factors.
  
  
  METHODS
  We used a multilevel modelling approach to quantify neighbourhood variation in self-reported sleep duration (very short <5 h; short 5-6.9 h; normative 7-8.9 h; long ≥9 h) among 3591 participants of the Boston Area Community Health Survey. We determined whether geographic variations persisted with control for individual-level demographic, socioeconomic status (SES) and lifestyle factors. We then determined the role of neighbourhood SES (nSES) in geographic variations. Additional models considered individual health factors.
  
  
  RESULTS
  Between neighbourhood differences accounted for a substantial portion of total variability in sleep duration. Neighbourhood variation persisted with control for demographics, SES and lifestyle factors. These characteristics accounted for a portion (6-20%) of between-neighbourhood variance in very short, short and long sleep, while nSES accounted for the majority of the remaining between-neighbourhood variances. Low and medium nSES were associated with very short and short sleep (eg, very short sleep OR=2.08; 95% CI 1.38 to 3.14 for low vs high nSES), but not long sleep. Further inclusion of health factors did not appreciably increase the amount of between-neighbourhood variance explained nor did it alter associations.
  
  
  CONCLUSIONS
  Sleep duration varied by neighbourhood in a diverse urban setting in the northeastern USA. Individual-level demographics, SES and lifestyle factors explained some geographic variability, while nSES explained a substantial amount. Mechanisms associated with nSES should be examined in future studies to help understand and reduce geographic variations in sleep.
authors.affiliation: New England Research Institutes, Inc, Watertown, Massachusetts, USA Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: New England Research Institutes, Inc, Watertown, Massachusetts, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Piccolo
authors.affiliation: New England Research Institutes, Inc, Watertown, Massachusetts, USA.
authors.forename: May
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: H Klar
authors.initials: HK
authors.lastname: Yaggi
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Bliwise
authors.affiliation: New England Research Institutes, Inc, Watertown, Massachusetts, USA.
authors.forename: Andre B
authors.initials: AB
authors.lastname: Araujo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001900:Boston; D005260:Female; D062305:Geographic Mapping; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D012111:Residence Characteristics / Q000145:classification* / Q000706:statistics & numerical data; D012890:Sleep; D012923:Social Class; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People
keywords: EPIDEMIOLOGY; GEOGRAPHY; Neighborhood/place; SOCIO-ECONOMIC