Dr Judite Blanc: Sleep Disorder Disparities Due to SDOH, Discrimination

The NIH All of Us Research Program is a National Institutes of Health (NIH)–funded initiative, with the goal to compile “one of the most diverse health databases in history,” according to the NIH, “to learn how our biology, lifestyle, and environment affect health.” The database will include information on social determinants of health, electronic health records (EHRs), and DNA, among others.

Judite Blanc, PhD, is research assistant professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine and the Center for Translational Sleep and Circadian Sciences. She is currently building out the Holistic Families lab to investigate and tackle unique stress responses among marginalized families, women, and children. She is also lead author on the abstract, “Social Determinants of Sleep Disorders Among Multiethnic Americans in the NIH All of Us Research Program,” which was presented today at SLEEP 2023.

Transcript

What is the NIH All of Us Research Program, and are there principal findings on sleep disorders that you would like to highlight?

It's such a unique data set because of this wide range of components—the risk factors, predictive factors, overall health—that they are investigating, and it’s the fact that it's also a program that gives you access, as a researcher, to an ancestrally diverse population, particularly everybody living in America. You can consider the NIH All of Us Research Initiative as the equivalent of the UK Biobank, but the only difference, the UK Biobank is mostly White.

Researchers, they are starting to dive in to All of Us. We want to understand what makes you sick and what keeps you healthy, and also what makes all of us unique. The NIH All of Us Research Program is also like a translation of precision medicine, because it's focused on the individual, giving you access to the right treatment at the right moment.

In terms of sleep disorders, in terms of our findings using All of Us, I'm presenting that at the SLEEP conference—but it's preliminary, very important to remember. We started this project at the end of 2022. We started a working group to investigate the relationship between specific components of social determinants of health assessed by the NIH All of Us Research Program with sleep disorders in general.

In terms of the most significant findings, we had [approximately] 250,000 participants that were available for analysis. We focused on a portion. What we did, we were interested in assessing lifetime recorded sleep disorders. So, if you have just 1 instance [of a] sleep disorder, we drop you; if you have 0 to 1, we drop you; and in your EHR, if we have 2 recorded sleep disorders, we include you in our sample. It was about 1%, so around less than 40,000 who have lifetime sleeping problems.

We found that in terms of association between sociodemographic characteristics and socioeconomic factors associated with sleep, for example, non-Whites—meaning Blacks, Asian, Hispanic—compared to White, they reported less sleeping problem diagnoses. And we also found that married individuals, those with no college education, those with lower income, non–US-born individuals, they reported lower sleeping diagnoses.

When it comes to the specifics, because again, since its preliminary data and [there is a] wide range of social determinants of health variables they have—it's a wealth of data—we cannot report everything all at once. So we focused on specific components, such as discrimination, such as income, employment, health insurance coverage—by the way, those with no health insurance coverage also reported less sleeping diagnoses—and we found that more than 50% of our participants of All of Us, they reported discrimination.

And among this population, gender, age, and weight were the most perceived reasons for discrimination. Gender came on top, then age, and weight. Also, discrimination and food insecurity were highly associated with sleeping diagnoses and sleep problems among All of Us. Of course, we have some explanation that we are providing for that. It's probably because of the previous factors that I mentioned before, probably because with All of Us, it’s really an EHR, it's not about self-reported data. As we know already, when it comes to insufficient sleep, it's really what you have in your EHR, what doctors reported for you when you visit for health care. So we think maybe this could be one of the explanations: self-reported vs clinically recorded.

We also think it could be due to education, awareness, and also lower access to health care and the fact that certain populations in certain neighborhoods, they have less access to sleep experts, to sleep clinics, and probably also a language barrier. I mentioned the fact that non-US-born, they had lower-reported sleeping problems. This could be due to the language barrier and also cultural competency, right? We believe that probably the providers working with a minoritized population, a non-White population, there may be a communication barrier, they may not have the adequate tools to communicate about sleep or the importance of sleep among those populations.