title: Socioeconomic status discrimination is associated with poor sleep in African-Americans, but not Whites.
abstract: BACKGROUND
  Research on self-reported experiences of discrimination and health has grown in recent decades, but has largely focused on racial discrimination or overall mistreatment. Less is known about reports of discrimination on the basis of socioeconomic status (SES), despite the fact that SES is one of the most powerful social determinants of health.
  
  
  OBJECTIVE
  We sought to examine the cross-sectional association between self-reported SES discrimination and subjective sleep quality, an emerging risk factor for disease. We further examined whether associations differed by race or SES.
  
  
  METHODS
  We used logistic and linear regression to analyze data from a population-based cohort of 425 African-American and White middle-aged adults (67.5% female) in the Southeastern United States. SES discrimination was assessed with a modified Experiences of Discrimination Scale and poor subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index.
  
  
  RESULTS
  In logistic regression models adjusted for age, gender, and education, reports of SES discrimination were associated with poor sleep quality among African-Americans (OR = 2.39 95%, CI = 1.35, 4.24), but not Whites (OR = 1.03, 95% CI = 0.57, 1.87), and the race × SES discrimination interaction was significant at p = 0.04. After additional adjustments for reports of racial and gender discrimination, other psychosocial stressors, body mass index and depressive symptoms, SES discrimination remained a significant predictor of poor sleep among African-Americans, but not Whites. In contrast to findings by race, SES discrimination and sleep associations did not significantly differ by SES.
  
  
  CONCLUSIONS
  Findings suggest that reports of SES discrimination may be an important risk factor for subjective sleep quality among African-Americans and support the need to consider the health impact of SES-related stressors in the context of race.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA. Electronic address: Mvandy2@emory.edu.
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Van Dyke
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA. Electronic address: lvaccar@emory.edu.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: Division of Cardiology, School of Medicine, Emory University, 1462 Clifton Road, NE, Suite 507, Atlanta, GA 30322, USA. Electronic address: aquyyum@emory.edu.
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA. Electronic address: tene.t.lewis@emory.edu.
authors.forename: Tené T
authors.initials: TT
authors.lastname: Lewis
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011287:Prejudice / Q000208:ethnology*; D012307:Risk Factors; D057566:Self Report; D012893:Sleep Wake Disorders / Q000208:ethnology*; D012923:Social Class; D015144:Southeastern United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: African-Americans; Sleep; Social discrimination