Abstract
Introduction
Insufficient sleep is associated with cardiometabolic risk and neurocognitive impairment.
Determinants of insufficient sleep include many social and environmental factors.
Assessment of geographic hot/coldspots may uncover novel risk groups and/or targets
for public health intervention. The aim of this study was to discern geographic patterns
in the first data set to include county-level sleep data.
Methods
The 2009 Behavioral Risk Factor Surveillance System was used. Insufficient sleep was
assessed with a survey item and dichotomized. Data from n = 2231 counties were available.
Tests for significant spatial concentrations of high/low levels of insufficient sleep
(hotspots/coldspots) used the Getis-Ord G* statistic of local spatial concentration,
chosen due to the nature of missing data.
Results
Eighty-four counties were hotspots, with high levels of insufficient sleep (P < .01), and 45 were coldspots, with low insufficient sleep (P < .01). Hotspots were found in Alabama (1 county), Arkansas (1), Georgia (1), Illinois
(1), Kentucky (25), Louisiana (1), Missouri (4), Ohio (7), Tennessee (12), Texas (9),
Virginia (6), and West Virginia (16). Coldspots were found in Alabama (1 county),
Georgia (2), Illinois (6), Iowa (6), Michigan (2), Minnesota (1), North Carolina (1),
Texas (7), Virginia (12), and Wisconsin (6). Several contiguous hotspots and coldspots
were evident. Notably, the 17 counties with the highest levels of insufficient sleep
were found in a contiguous set at the intersection of Kentucky, Tennessee, Virginia,
and West Virginia (all P < .0002).
Conclusions
Geographic distribution of insufficient sleep in the United States is uneven. Some
areas (most notably parts of Appalachia) experience disproportionately high amounts
of insufficient sleep and may be targets of intervention. Further investigation of
determinants of geographic variability needs to be explored, which would enhance the
utility of these data for development of public health campaigns.
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Article info
Publication history
Published online: August 10, 2015
Accepted:
June 22,
2015
Received in revised form:
June 20,
2015
Received:
January 16,
2015
Footnotes
☆Supported by the National Institute of Environmental Health Sciences (R21ES022931) and the Cartographic Modeling Lab at the University of Pennsylvania (Philadelphia, PA).
Identification
Copyright
© 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
