Neighborhood-level sleep health and childhood opportunity index at the census tract level: comparison to other health indicators

Abstract Introduction Promoting sleep health at the neighborhood level may be an efficient way to promote overall health and well-being. This study examined the relative contribution of sleep health, versus other regional health metrics. Methods Neighborhood sleep health values were obtained from the “500 Cities” data collected by the CDC, which includes census tract and proportion that report values associated with health. Data include the population of each census tract as well as census-estimated proportion of the population in each census tract that report obtaining at least 7 hours of sleep. Other health indicators evaluated included access to health insurance, past-year routine medical or dental checkup, older adult preventive care, leisure-time activity, mammography, pap testing, and prevalence of arthritis, binge drinking, hypertension, antihypertensive use, cancer, asthma, coronary disease, cholesterol screening, colon screening, COPD, smoking, diabetes, hypercholesterolemia, kidney disease, poor mental and physical health, obesity, stroke, and teeth lost. The Child Opportunity Index (COI) is a publicly-available index (DiversityDataKids.org) reported at the census tract level. It provides indices for “Education,” “Health and Environment,” and “Social and Economic” domains, as well as a global score. The present analysis merged the 500 Cities data with the COI data, using census tract as the matching variable. When data were merged, 27,130 census tracts were included. Results In stepwise analyses adjusted for population size, with global COI as the dependent variable, sleep health emerged as the strongest predictor, accounting for 57.2% of the variance of global COI (p<0.0001). When all other health predictors were included in the model, the next largest contributors were teeth lost (additional 15.5%), health insurance (additional 3.0%), and asthma (additional 1.4%). Similarly, when stepwise analyses examined each component of COI as dependent variable, sleep health consistently emerged as the most substantial predictor, accounting for 41.2%, 24.3%, and 56.4% of the variance of “Education,” “Health and Environment,” and “Social and Economic” scores, respectively (all p<0.0001). Conclusion Sleep health is more strongly associated with overall COI (and all its components) than any other regional health metric. Public health efforts targeting sleep health may have disproportionately beneficial impact on factors that support family health and well-being. Support (If Any)