Sleep Trajectories and All-Cause Mortality Among Low-Income Adults

Authors

Kelsie M Full
Hui Shi
Loren Lipworth
Lawrence T Dauer
Michael T Mumma
Qian Xiao

Publication Date

2-3-2025

Journal

JAMA Network Open

Abstract

IMPORTANCE: Short and long sleep durations are adversely associated with cardiovascular disease (CVD), type 2 diabetes, and mortality. It remains unclear how sleep duration trajectories over time are associated with mortality and whether these associations vary by well-documented sex, race, and socioeconomic sleep disparities.

OBJECTIVE: To investigate the association of 5-year sleep duration trajectories with all-cause and cause-specific mortality among US adults, predominantly those in low-income groups.

DESIGN, SETTING, AND PARTICIPANTS: The Southern Community Cohort Study included participants aged 40 to 79 years recruited and enrolled (from March 2002 to September 2009) from community health centers by using random sampling methods across 12 states in the Southeastern US. Participants completed a follow-up survey between 2008 and 2013. Data analysis was performed from August 10 to November 30, 2023.

EXPOSURES: Sleep duration was self-reported at study enrollment and at 5-year follow-up. At each time point, sleep was categorized as short (<7 >hours), healthy (7-9 hours), or long (>9 hours). Nine sleep trajectories were defined based on 5-year change or consistency in sleep duration category between enrollment and follow-up.

MAIN OUTCOME AND MEASURES: Cause of death was ascertained via linkage to the National Death Index through December 31, 2022. Multivariable-adjusted Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs) and 95% CIs for mortality outcomes (all-cause, CVD, cancer, and neurodegenerative disease) associated with sleep duration trajectory.

RESULTS: Participants included 46 928 adults (mean [SD] age, 53.0 [8.8] years; 65.4% women; 63.3% self-identified as Black and 36.7% as White; and 47.5% with a household income

CONCLUSIONS AND RELEVANCE: In this cohort study of 46 928 US residents, nearly two-thirds of participants had suboptimal 5-year sleep duration trajectories. Suboptimal sleep duration trajectories were associated with as much as a 29% increase in risk of all-cause mortality. These findings highlight the importance of maintaining healthy sleep duration over time to reduce mortality risk.

Keywords

Humans, Middle Aged, Male, Female, Aged, Adult, Poverty, Cause of Death, Cardiovascular Diseases, Sleep, Cohort Studies, Mortality, Southeastern United States, Time Factors

DOI

10.1001/jamanetworkopen.2024.62117

PMID

40014341

PMCID

PMC11868971

PubMedCentral® Posted Date

2-27-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes