# Sleep Health Inequities: Sociodemographic, Psychosocial, and Structural Determinants of Short Sleep in U.S. Adults

## TL;DR

This study finds that sleep health in the U.S. is unequal, with certain groups sleeping less and facing higher health risks.

## Contribution

The study identifies novel sociodemographic, psychosocial, and structural factors linked to short sleep in U.S. adults using recent national data.

## Key findings

- Non-Hispanic Black and American Indian/Alaska Native adults had higher odds of short sleep compared to non-Hispanic White adults.
- Psychosocial factors like life dissatisfaction and low social connectedness strongly increased the odds of short sleep.
- Food insecurity and smoking were significant contributors to short sleep, while binge drinking and urbanicity were not.

## Abstract

Short sleep duration (≤6 h) is a public health concern linked to cardiometabolic disease and premature mortality. However, persistent disparities across sociodemographic, psychosocial, and structural domains remain underexplored in recent nationally representative samples. We analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, including 228,463 adults (weighted N ≈ 122 million). Sleep duration was dichotomized as short (≤6 h) versus adequate (≥7 h). Complex samples logistic regression estimated associations between sociodemographic, psychosocial, behavioral, and structural determinants and short sleep, accounting for survey design. The weighted prevalence of short sleep was 33.2%. Non-Hispanic Black (AOR = 1.56, 95% CI: 1.46–1.65) and American Indian/Alaska Native adults (AOR = 1.46, 95% CI: 1.29–1.65) were disproportionately affected compared with non-Hispanic White adults. Psychosocial factors contributed strongly: life dissatisfaction, limited emotional support, and low social connectedness increased odds, whereas high connectedness was protective. Food insecurity and smoking were significant structural and behavioral risks, while binge drinking and urbanicity were not. One-third of U.S. adults report short sleep, with marked disparities across demographic, socioeconomic status, psychosocial stressors, and structural barriers. Findings highlight the multifactorial nature of sleep health inequities and the need for multilevel interventions addressing both individual behaviors and upstream determinants.