Sleep

Decomposition of racial and ethnic disparities in sleep health among US adults, NHANES from 2005-2008 and 2015-2018.

TL;DR

Education level, age, food security, and BMI substantially contribute to racial and ethnic disparities in average healthy sleep scores among US adults.

Key Findings

Average healthy sleep scores differed across racial and ethnic groups, with non-Hispanic Black adults scoring lowest.

  • Average (SE) healthy sleep score was 3.12 (0.03) in Hispanic adults, 2.84 (0.02) in non-Hispanic Black adults, 3.03 (0.02) in non-Hispanic White adults, and 3.15 (0.04) in other race/ethnicity adults.
  • The healthy sleep score was constructed from five components: 7–8 hours of sleep per day, no trouble sleeping, no snoring, no excessive daytime sleepiness, and no nocturia, each worth 1 point.
  • The sample included 17,476 participants representing an estimated 109,108,231 non-institutionalized US adults aged ≥20 years after applying sample weights.
  • The racial/ethnic composition was 67.8% non-Hispanic White, 13.7% Hispanic, 10.9% non-Hispanic Black, and 7.6% other racial/ethnic groups.

Among non-Hispanic Black adults compared with non-Hispanic White adults, higher educational level was associated with a higher healthy sleep score.

  • The difference in healthy sleep scores attributable to education level among non-Hispanic Black adults was +0.03 (SE = 0.01), P < 0.001.
  • This indicates that the relatively higher educational attainment among non-Hispanic Black adults partially offset the overall sleep score disparity compared to non-Hispanic White adults.
  • Blinder-Oaxaca decomposition was the analytic method used to quantify these contributions.

Among non-Hispanic Black adults compared with non-Hispanic White adults, lower prevalence of food insecurity was associated with a higher healthy sleep score.

  • The difference in healthy sleep scores attributable to food security among non-Hispanic Black adults was +0.06 (SE = 0.01), P < 0.001.
  • Food security was one of the individual-level factors included in the Blinder-Oaxaca decomposition alongside age, sex, marital status, education level, smoking status, alcohol intake, physical activity, BMI, place of birth, health insurance, and household income.

Among Hispanic adults compared with non-Hispanic White adults, younger average age was associated with a higher healthy sleep score.

  • The difference in healthy sleep scores attributable to age among Hispanic adults was +0.08 (SE = 0.01), P < 0.001.
  • This suggests that the younger age distribution of the Hispanic adult population partially contributed to their higher average sleep score relative to non-Hispanic White adults.

Among Hispanic adults compared with non-Hispanic White adults, lower educational level was associated with a higher healthy sleep score.

  • The difference in healthy sleep scores attributable to education among Hispanic adults was +0.11 (SE = 0.03), P < 0.001.
  • This finding is in the direction opposite to what might be expected, suggesting that the specific distribution of educational attainment among Hispanic adults contributed positively to their sleep scores relative to non-Hispanic White adults in this decomposition framework.
  • Data were drawn from NHANES 2005–2008 and 2015–2018 survey cycles.

Education level, age, food security, and BMI were identified as the most important individual-level factors explaining racial and ethnic disparities in healthy sleep scores.

  • The study used Blinder-Oaxaca decomposition to quantify the extent to which differences in distributions of individual-level factors explain group-level sleep disparities.
  • Other factors examined but found to be less dominant contributors included sex, marital status, smoking status, alcohol intake, physical activity, place of birth, health insurance, and household income.
  • The analysis covered two time periods: NHANES 2005–2008 and 2015–2018.

What This Means

This research suggests that racial and ethnic differences in sleep health among U.S. adults are not random but can be partly explained by measurable social and demographic factors. Using data from nearly 17,500 adults surveyed between 2005 and 2018, the researchers scored each person's sleep health on a scale of 0 to 5 based on sleep duration, trouble sleeping, snoring, daytime sleepiness, and nighttime urination. They found that non-Hispanic Black adults had the lowest average sleep health scores, while Hispanic and 'other race' adults actually scored slightly higher than non-Hispanic White adults on average. To understand why these differences exist, the researchers used a statistical technique called Blinder-Oaxaca decomposition, which breaks down group differences into the portions explained by specific factors. They found that education level, age, food security, and body weight (BMI) were the most important contributors to these disparities. For example, among Hispanic adults, being younger on average and having a particular distribution of educational attainment were associated with relatively better sleep scores compared to non-Hispanic White adults. Among non-Hispanic Black adults, relatively higher education levels and lower food insecurity contributed positively to their scores, though their overall average sleep score remained the lowest. This research suggests that addressing social determinants of health—particularly food insecurity and educational inequities—could be meaningful targets for reducing sleep health disparities across racial and ethnic groups in the United States. The findings highlight that sleep differences between groups are not simply biological but are shaped by social and economic conditions.

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Citation

Yuan X, Cai L, Huang H, Chen Z, Zhang Y, Zhan Y, et al.. (2026). Decomposition of racial and ethnic disparities in sleep health among US adults, NHANES from 2005-2008 and 2015-2018.. BMC public health. https://doi.org/10.1186/s12889-026-26531-0