Temporal Trends in Racial and Ethnic Disparities in Sleep Duration in the United States, 2004–2018

Importance Minoritized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed over recent years. Objective To determine 15-year trends in the racial and ethnic differences in self-reported sleep duration among adults in the US. Design Serial cross-sectional study of the National Health Interview Survey from years 2004– 2018. Analyses were performed between July 26, 2021 and February 10, 2022. Setting US population-based. Participants 429,195 non-institutionalized adults. Exposures Self-reported race, ethnicity, household income, and sex/gender. Main Outcomes Temporal trends and racial/ethnic differences in short- and long-sleep duration (<7 and >9 hours in a 24-hour period, respectively), and racial/ethnic differences in the relationship between sleep duration and age. Results The study sample consisted of 429,195 individuals (mean age 46.5 [SE, 0.08] years; 51.7% female) of which 5.1% identified as Asian, 11.8% as Black, 14.7% as Latino/Hispanic, and 68.5% as White. In 2004, the adjusted estimated prevalence of short-sleep duration and long-sleep duration, respectively, were 31.3% and 2.5% among Asian individuals, 35.3% and 6.4% among Black individuals, 27.0% and 4.6% among Latino/Hispanic individuals, and 27.8% and 3.5% among White individuals. Over the study period, there was a significant increase in the short sleep prevalence among Black, Latino/Hispanic, and White individuals (P≤0.001 for each), whereas prevalence of long sleep changed significantly only among Latino/Hispanic individuals (−1.4 points, P=0.01). In 2018, compared with White individuals, short sleep prevalence among Black and Latino/Hispanic individuals was higher by 10.7 points and 2.4 points, respectively (P≤0.03 each), and long sleep prevalence was higher only among Black people (+1.4 points; P=0.01). The short-sleep disparities were the greatest among women and among those with middle/high household income. In addition, across age groups, Black individuals had a higher short- and long-sleep duration prevalence compared with White individuals of their same age. Conclusions In this serial cross-sectional study from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals. The Black-White disparities in short-sleep were highest among women, individuals who had middle or high income, and among young or middle-aged adults. Question How have racial and ethnic differences in self-reported sleep duration among US adults changed between 2004 and 2018? Findings In this serial cross-sectional study that included 429,195 adults, the prevalence of both short and long sleep duration were persistently higher among Black individuals over the 15-year study period. The disparities in short sleep duration were highest for Black women, Black individuals with middle or high income, and young and middle-aged Black adults. Meaning There were marked racial and ethnic differences in sleep duration that persisted from 2004 to 2018, which may be contributing to health disparities. ### Competing Interest Statement In the past three years, Harlan Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, and Martin/Baughman Law Firm. He is a co-founder of Refactor Health and HugoHealth, and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from Johnson & Johnson. Dr. Murugiah works under contract with the Centers for Medicare & Medicaid Services to support quality measurement programs. Dr. Lu is supported by the National Heart, Lung, and Blood Institute (K12HL138037) and the Yale Center for Implementation Science. Drs. Roy and Riley are consultants for the Institute for Healthcare Improvement. The other co-authors report no potential competing interests. ### Funding Statement This research was funded, in part, by the Intramural Program at the NIH, National Institute of Environmental Health Sciences (Z1AES103325-01). Otherwise, this study was self-funded. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board at Yale University exempted the study from review as NHIS data are publicly available. All data is publicly available from the Integrated Public Use Microdata Series Health Surveys (). The code used to analyze these data is publicly available at . I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data is publicly available from the Integrated Public Use Microdata Series Health Surveys (). The code used to analyze these data is publicly available at .