Unemployment and sleep: evidence from the United States and Europe

Do type, timing and duration of life course non-employment differentially predict dementia risk? An application of sequence analysis

Periods out of employment may influence dementia, but characterizing lifecourse employment is difficult and prior research is sparse. This study used sequence and cluster analysis to characterize type, timing, and duration of lifecourse work gaps and estimate associations with dementia risk. Life History Mail Survey supplement to the U.S. Health Retirement Study participants (N = 5,945, 13.6 % of the Health and Retirement Study sample) reported lifecourse employment (full time or part time) and reasons and age of work gaps (unemployment, schooling, caregiving, or disability). Our exposure was gender-stratified employment trajectories from age 18-65, characterized using sequence analysis and cluster analysis. Our outcomes were algorithmically defined dementia probability scores and memory scores. We estimated the association between employment trajectories and dementia risk using generalized estimating equations and memory decline using linear mixed effect models, adjusted for age, gender, birthplace, and childhood socioeconomic status. We identified 11 employment trajectories for women (including predominant work, disability, unemployment, caregiving, retirement) and 10 for men (similar, but no caregiving). Compared to "predominant work", "disability" and "unemployment" trajectories were associated with higher dementia risk for men and women (e.g., disability among women: OR = 3.62; 95 % CI = 2.25, 5.81). Among women who cared for family, those who did not re-enter the labor force full-time had higher dementia risk (e.g. "family gap, go back part time": OR = 1.79; 95 % CI = 1.15, 2.79) compared to the predominant work cluster. Women who cared for family and returned to full-time work had similar cognitive outcomes to those in the predominant work cluster. Men who had long spells of part-time work also had elevated dementia risk (e.g. part time earlier: OR = 1.64; 95 % CI = 1.16, 2.57). Finally, women and men with long periods of unreported employment status had higher dementia risk than those in the predominant work trajectory. Results suggest the type, timing and duration of work gaps are differentially associated with dementia risk. Work gaps due to disability, unemployment or unreported employment status predicted higher dementia risk. Permanently leaving full-time work for caregiving predicted worse cognitive outcomes but temporary caregiving-related work interruptions did not.

Involvement of common risk factors in the associations between lifetime unemployment exposure, major health outcomes and mortality: a retrospective and prospective study in a large population-based French cohort

OBJECTIVES

Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality.

DESIGN

A retrospective and prospective observational study.

SETTING

A large population-based French cohort (CONSTANCES).

PARTICIPANTS

99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline.

PRIMARY OUTCOME MEASURES

Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions.

RESULTS

Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0010 (0.0007 to 0.0014), p<0.0001 on cardiovascular disease rate; 0.0059 (0.0028 to 0.0089), p=0.0002 and 0.0007 (0.0004 to 0.0010), p<0.0001 on cancer rate; 0.0105 (0.0058 to 0.0151), p<0.0001 and 0.0010 (0.0005 to 0.0014), p<0.0001 on all-cause mortality. The figures for alcohol consumption are, respectively, 0.0076 (0.0034 to 0.0118), p=0.0004 and 0.0004 (0.0002 to 0.0005), p=0.0006; 0.0067 (0.0035 to 0.0100), p<0.0001 and 0.0004 (0.0002 to 0.0005), p<0.0001; 0.0114 (0.0064 to 0.0164), p<0.0001 and 0.0004 (0.0001 to 0.0006), p=0.0009. For depressive symptoms, 0.0084 (0.0040to 0.0128), p=0.0002 and 0.0007 (0.0002 to 0.0011), p=0.005; 0.0053 (0.0017 to 0.0089), p=0.004 and 0.0001 (-0.0002 to 0.0005), p=0.51; 0.0088 (0.0031 to 0.0144), p=0.002 and 0.0010 (0.0004 to 0.0015), p=0.0005. For leisure-time physical inactivity, 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0003 (0.0001 to 0.0005), p=0.0006; 0.0057 (0.0026 to 0.0088), p=0.0004 and 0.0002 (0.0001 to 0.0003), p=0.002; 0.0105 (0.0058 to 0.0152), p<0.0001 and 0.0004 (0.0002 to 0.0007), p<0.0001. For blood triglycerides, 0.0080 (0.0042 to 0.0119), p<0.0001 and 0.0005 (0.0004 to 0.0007), p<0.0001; 0.0057 (0.0026 to 0.0087), p=0.0003 and 0.0001 (-0.0001 to 0.0002), p=0.32; 0.0103 (0.0057 to 0.0149), p<0.0001 and 0.0002 (0.0000 to 0.0004), p=0.06. The figures for all risk factors when tested together were 0.0075 (0.0022 to 0.0128), p=0.005 and 0.0020 (0.0011 to 0.0027), p<0.0001; 0.0052 (0.0011 to 0.0093), p=0.01 and 0.015 (0.0009 to 0.0020), p<0.0001; 0.0102 (0.0035 to 0.0169), p=0.003 and 0.0022 (0.0011 to 0.0031), p<0.0001.

CONCLUSIONS

These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.

Employment, income, and sleep in South Africa: An actor-partner interdependence model approach

OBJECTIVE

We analyze the relationship between employment status, income, and sleep in South Africa to address two research questions: (1) How does employment status influence the sleep quantity of the individual and their partner? (2) How does income impact the sleep quantity of the individual and their partner?

METHOD

Using data from 1600 Black African couples in the South African Time Use Study, we employ the Actor-Partner Interdependence Model to investigate the relationship between employment status, income, and sleep in couples. We categorize nighttime sleep into three categories: recommended sleep (7-9 hours), short sleep (<7 hours), and long sleep (>9 hours).

RESULTS

Employed individuals were more likely to get the recommended amount of sleep and less likely to experience long sleep. However, men whose wives are employed are almost twice as likely as men whose wives are unemployed to experience short sleep, and they experience 47% lower risk of long sleep. Men with a medium level of income have a higher risk of short sleep than those with low income, while those in the highest income category are more likely to get the recommended amount of sleep.

CONCLUSION

These results highlight the intricate dynamics between managing employment demands and securing economic stability for both men and women in the context of high unemployment and shifting gender norms.

COVID-19 employment shocks and safety net expansion: Health effects on displaced workers

COVID-19 precipitated sharp job losses, concentrated in the service sector. Prior research suggests that such shocks would negatively affect health and wellbeing. However, the nature of the pandemic crisis was distinct in ways that may have mitigated any such negative effects, and historic expansions in unemployment insurance (UI) may have buffered workers from negative health consequences. We draw on employer-employee linked cross-sectional (N = 15,219) and panel (N = 3307) data from service sector workers to estimate the effects of job loss on health and wellbeing during COVID-19. Using employer fixed-effects, lagged dependent variables, and models that focus on job loss due to establishment closure to minimize confounding, we find negative effects of unemployment on health and wellbeing. However, in periods when UI was most generous or in cases where UI fully replaced pre-job loss wages, unemployed workers who received UI were no worse off than those who remained employed. Although UI protected against worsening health, receiving generous UI benefits did not confer a health advantage relative to working at the height of the pandemic.

Disadvantaged social status contributed to sleep disorders: An observational and genome-wide gene-environment interaction analysis

BACKGROUND

Sleep is a natural and essential physiological need for individuals. Our study aimed to research the associations between accumulated social risks and sleep disorders.

METHODS

In this study, we came up with a polysocial risk score (PsRS), which is a cumulative social risk index composed of 13 social determinants of health. This research includes 239,165 individuals with sleep disorders and social determinants of health data from the UK Biobank cohort. First, logistic regression models were performed to examine the associations of social determinants of health and sleep disorders, including chronotype, narcolepsy, insomnia, snoring, short and long sleep duration. Then, PsRS was calculated based on statistically significant social determinants of health for each sleep disorder. Third, a genome-wide gene-environment interaction study was conducted to explore the interactions between single-nucleotide polymorphisms and PsRS in relation to sleep disorders.

RESULTS

Higher PsRS scores were associated with worse sleep status, with the adjusted odds ratio (OR) ranging from 1.10 (95% Confidence interval [CI]: 1.09-1.11) to 1.29 (95% CI: 1.27-1.30) for sleep disorders. Emotional stress (OR = 1.36, 95% CI: 1.28-1.43) and not in paid employment (OR = 2.62, 95% CI: 2.51-2.74) were found to have significant contributions for sleep disorders. Moreover, multiple single-nucleotide polymorphisms were discovered to have interactions with PsRS, such as FRAS1 (P = 2.57 × 10-14) and CACNA1A (P = 8.62 × 10-14) for narcolepsy, and ACKR3 (P = 1.24 × 10-8) for long sleep.

CONCLUSIONS

Our findings suggested that cumulative social risks was associated with sleep disorders, while the interactions between genetic susceptibility and disadvantaged social status are risk factors for the development of sleep disorders.

An Exploratory Analysis of Preclinical and Clinical Factors Associated With Sleep Disturbance Assessed via the Neuro-QoL After Hemorrhagic Stroke

Background and Purpose

Sleep disturbance after hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) can impact rehabilitation, recovery, and quality of life. We sought to explore preclinical and clinical factors associated with sleep disturbance after hemorrhagic stroke assessed via the Quality of Life in Neurological Disorders (Neuro-QoL) short form sleep disturbance inventory.

Methods

We telephonically completed the Neuro-QoL short form sleep disturbance inventory 3-months and 12-months after hemorrhagic stroke for patients >18-years-old hospitalized between January 2015 and February 2021. We examined the relationship between sleep disturbance (T-score >50) and social and neuropsychiatric history, systemic and neurological illness severity, medical complications, and temporality.

Results

The inventory was completed for 70 patients at 3-months and 39 patients at 12-months; 18 (26%) had sleep disturbance at 3-months and 11 (28%) had sleep disturbance at 12-months. There was moderate agreement (κ = .414) between sleep disturbance at 3-months and 12-months. Sleep disturbance at 3-months was related to unemployment/retirement prior to admission (P = .043), lower Glasgow Coma Scale score on admission (P = .021), higher NIHSS score on admission (P = .041) and infection while hospitalized (P = .036). On multivariate analysis, sleep disturbance at 3-months was related to unemployment/retirement prior to admission (OR 3.58 (95% CI 1.03-12.37), P = .044). Sleep disturbance at 12-months was related to premorbid mRS score (P = .046).

Conclusion

This exploratory analysis did not demonstrate a sustained relationship between any preclinical or clinical factors and sleep disturbance after hemorrhagic stroke. Larger studies that include comparison to patients with ischemic stroke and healthy individuals and utilize additional techniques to evaluate sleep disturbance are needed.

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Importance

Racial disparities in sleep health may mediate the broader health outcomes of structural racism.

Objective

To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.

Design, Setting, and Participants

Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023.

Exposures

Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview.

Main Outcomes and Measures

Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours).

Results

Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep.

Conclusions and Relevance

Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

Comparing the Prevalence of Sleep Disorders Among Underweight, Normal, Overweight, and Obese Adults in Riyadh, Saudi Arabia

Background Sleep disorders are prevalent worldwide and can have a negative impact on physical and psychological well-being. Numerous studies have explored the reciprocal connection between obesity and sleep disorders. This study aimed to compare the prevalence of sleep disorders among underweight, normal, overweight, and obese adults in Riyadh, Saudi Arabia. Methods This cross-sectional study was conducted on 378 adults visiting primary healthcare centers in Riyadh, Saudi Arabia, from August to November 2022. Data were collected using a self-administered questionnaire that included a section for demographic data and the SLEEP-50 questionnaire in both English and Arabic languages. Results Most of the participants were aged between 25 and 34 years (37.6%), 79.1% were females and 59.5% were either overweight or obese. Most participants (78.3%) had at least one sleep disorder, with narcolepsy being the most frequent disorder (65.1%), and 23% had two combined sleep disorders. Obese and overweight patients were significantly more likely to have sleep disorders (p=0.011), and obese patients were more likely to have all sleep disorders (p=0.049). Conclusion The prevalence of sleep disorders, namely narcolepsy and insomnia, is high among adults in Riyadh, Saudi Arabia. Moreover, sleep disorders are significantly associated with obesity. Evaluation and management of sleep disorders in clinical settings among patient with overweight or obese is important to improve their quality of life and to prevent physical and psychological complications.

Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort

It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23-1.57)), disability for routine tasks (1.41 (1.26-1.57)) and several cardiovascular diseases including stroke (1.66 (1.19-2.31)), myocardial infarction (1.65 (1.18-2.31)) and peripheral arterial disease (2.38 (1.46-3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04-1.33)) and cancers (1.27 (1.04-1.54)), notably prostate cancer (1.60 (1.01-2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors.

Berry Consumption and Sleep in the Adult US General Population: Results from the National Health and Nutrition Examination Survey 2005-2018

INTRODUCTION

Poor sleep is associated with numerous adverse health outcomes. Berries are rich in micronutrients and antioxidants that may improve sleep quality and duration. We determined the association of berry consumption and sleep duration and sleep difficulty among adult participants in NHANES.

METHODS

We analyzed the diet of US adults aged ≥ 20 y using two non-consecutive 24 h recalls from the National Health and Nutrition Examination Survey 2005 to 2018 (N = 29,217). Poor sleep quality was measured by sleep duration (short sleep duration: <7 h), long sleep (≥9 h), and reported sleep difficulty. The relative risk of poor sleep outcomes for berry consumers vs. nonconsumers was modelled using population weight-adjusted multivariable general logistic regression.

RESULTS

About 46% of participants reported inadequate sleep duration, and 27% reported sleep difficulties. Twenty-two percent reported consuming berries. Berry consumers had a 10-17% decreased risk of short sleep. The findings were consistent for specific berry types including strawberries and blueberries (p < 0.05). No significant associations with long sleep were found for total berries and any berry types. A decreased risk of sleep difficulties was found to be linked to blackberry consumption (adjusted OR = 0.63, 95% CI: 0.40-0.97; p = 0.036) but not for other berries.

CONCLUSIONS

US adult berry consumers had a decreased risk of reporting short sleep compared to nonconsumers. Berries are underconsumed foods in the US adult population, and increased berry consumption may improve sleep quality.

Too stressed to sleep? Downsizing, job insecurity and sleep behavior

While workforce downsizing can benefit firms by increasing efficiency, it also leads to a deterioration of worker job security. This study uses German survey data to investigate the impact of downsizing on quality and quantity of sleep. While the topic is largely unexplored, it is of central importance, as sleep is not only the most time-consuming activity in the life of individuals, but also highly essential for productivity, health, and life itself. To address potential endogeneity, the study employs three measures of downsizing: Workforce reduction at the firm level, dismissal rate at the industry level, and nationwide news of downsizing. The results show that all three measures of downsizing lead to poor sleep. The study further investigates the role of job insecurity as a potential mechanism. Instrumental variable estimates indicate that perceived job insecurity strongly increases the probability of insufficient sleep.

Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort

OBJECTIVES

Distinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks.

DESIGN

A cross-sectional and retrospective observational study.

SETTING

A population-based French cohort (CONSTANCES).

PARTICIPANTS

130 197 adults enrolled between 2012 and 2021 without missing values.

PRIMARY OUTCOME MEASURES

The associations of social position, work environment and unemployment exposure with the prevalence of cardiovascular events and cancers simultaneously tested using logistic regression models adjusting for common risk factors.

RESULTS

While social position, work environment and unemployment exposure are strongly inter-related with each other, they are not linked to the same cardiovascular and cancer outcomes. Low social position and long unemployment duration are significantly associated with an increased prevalence of angina pectoris, myocardial infarction and peripheral arterial disease (OR=1.22 to 1.90, p<0.04 to p<0.0001) but not of stroke. In contrast, a bad work environment is associated with an increased prevalence of stroke (OR=1.29, p<0.01) but not of angina pectoris, myocardial infarction and peripheral arterial disease. Low social position is associated with an increased prevalence of cervical and lung cancers (OR=1.73 and 1.95, p<0.002 and p<0.03) and a decreased prevalence of skin cancer (OR=0.70, p<0.0001) while a bad work environment is associated with an increased prevalence of breast, skin, prostate and colon cancers (OR=1.31 to 2.91, p<0.0002 to p<0.0001). Unemployment exposure is not associated with the prevalence of any type of cancers.

CONCLUSIONS

Social position, work environment and unemployment are associated with distinct cardiovascular and cancerous diseases that could add up during lifetime, they should therefore be considered all together in any preventive strategy.

Cardiovascular burden and unemployment: A retrospective study in a large population-based French cohort

The specific effect of unemployment on cardiovascular health relatively to the effects of social position and work environment is still unclear. To clarify this effect, the associations between current or past unemployment and the prevalence of common cardiovascular risk factor and events were tested using multiple logistic regression models with adjustment for both social position and prior work environment. The analyses were performed in a population-based French cohort (CONSTANCES) that included 131,186 adults enrolled between 2012 and 2021. Participants who were unemployed at inclusion (n = 8278) were overexposed to non-moderate alcohol consumption, smoking, leisure-time physical inactivity and depression (odds ratios (ORs) from 1.19 to 1.58) whereas those who have been unemployed at least once in the past (n = 19,015) were additionally overexposed not only to the previous risk factors but also to obesity, diabetes and sleep disorders (ORs from 1.10 to 1.35). These latter were also more exposed to non-fatal myocardial infarction and peripheral arterial disease (ORs of 1.44 and 1.47 respectively), overexposures that persisted after further adjustment for cardiovascular risk factors (ORs of 1.36 and 1.33). The overexposures to risk factors and cardiovascular events were both dependent on the duration of past unemployment. They were equally observed in participants with low social position or bad work environment. These results suggest that unemployment increases cardiovascular risk independently from social position and work environment with a cumulative effect over time. The effect of unemployment could add up to those of low social position and bad work environment during lifetime to further increase cardiovascular risk. They also suggest that long-term unemployment increases the prevalence of cardiovascular events through pathways including but not limited to overexposure to common risk factors.

Longitudinal Trends in Sleep and Related Factors Among South Korean Adults From 2009 to 2018

BACKGROUND AND PURPOSE

Excess or insufficient sleep, irregular sleep-wake patterns, and an extreme early or late chronotypes adversely impact physical and mental health. Changes in sleep characteristics should therefore be tracked, and factors that contribute to poor sleep should be identified. We investigated the changes in sleep patterns among South Korean adults during 2009-2018.

METHODS

Using data of a representative sample of South Korean adults from the 2009 (n=2,658, 48.5% males; age=44.5±15.0 years old [mean±standard deviation], age range=19-86 years) and 2018 (n=2,389, 49.1% males; age=47.9±16.3 years, age range=19-92 years) Korean Headache-Sleep Study, we explored changes in sleep timing, sleep duration, chronotype, and social jetlag (SJL). Logistic regression analysis was used to examine the association between average sleep duration and depression.

RESULTS

From 2009 to 2018, bedtimes were advanced by 10 and 25 min on workdays and free days, respectively. Meanwhile, wake-up times were advanced by 13 min and delayed by 12 min on workdays and free days, respectively. The average sleep duration significantly decreased from 7.45 h to 7.13 h. The prevalence of short sleep duration (<7 h) increased, whereas that of long sleep duration (≥8 h) decreased. A circadian preference toward eveningness and SJL increased. The prevalence of depression increased from 4.6% to 8.4%, and there were significant reverse J-shaped and U-shaped associations between average sleep duration and depression in 2009 and 2018, respectively.

CONCLUSIONS

Changes in sleep patterns and the association between sleep duration and depressive mood were determined from a representative sample of the South Korean adult population. Interventions to modify sleep behaviors might improve public health.

The association between chronotype and wages at mid-age

Sleep has been shown to affect economic outcomes, including wages. The mechanisms by which sleep affects wages remain unclear. We examine the relationship between chronotype - morning larks, evening owls - and wages at mid-age. We propose a novel model relating chronotype to wages in consideration of human, social, and health capital constructs. Empirically, we explore the effects of chronotype mediated through life course choices, such as work experience, trust, and health behaviour. The data come from the 46-year-old follow-up study of the Northern Finland Birth Cohort (1966) and from registers of the Finnish Tax Administration. We find evening chronotype to have a significant indirect negative effect on wages, which occurs through accumulating less work experience and through poor health outcomes. The effect is largest for male workers, with a total indirect effect on average wages of - 4%. We also provide evidence that chronotype has a long-term association with wages between 29 and 50 years of age. We conclude that evening-type workers are less suited to typical working hours and accumulate less human, social and health capital which in turn negatively affects their wages. Our findings are of great socio-economic importance because evening chronotypes make up a significant part of the population.

Exploring the relationship between unemployment perception and health during COVID-19: a comparative study of rural and urban adults in China

Introduction

The COVID-19 pandemic has significantly impacted global economies and individual health. This study uses data from the China Family Panel Data (CFPS) in 2018 (before the pandemic) and 2020 (during the pandemic) to a) estimate the relationships between the perceived risk of unemployment and individuals' mental health, physical health, and health behaviors; and b) explore the variations of these relationships between rural and urban adults in China.

Methods

Ordinary linear regression models or Logit models are employed, depending on the nature (continuous vs. discrete) of the dependent variables.

Results

We find that the perceived risk of unemployment was statistically and positively associated with the risk of depression, and the association was greater for rural adults than for urban adults. Rural-urban variations were observed in various dimensions. For rural adults, the perceived risk of unemployment was statistically and negatively associated with life satisfaction, the probability of gaining weight and becoming obese, the probability of having adequate sleep, and computer-based screen time. These associations were statistically insignificant for urban adults. On the other hand, the perceived risk of unemployment was statistically and negatively associated with self-rated very-good-to-excellent health condition and health-compromising behaviors (e.g., smoking and drinking) for urban adults; but such associations were statistically insignificant for rural adults.

Discussion

These findings suggest that rural and urban adults exhibited different psychological and behavioral responses to the unemployment risk during the COVID-19 pandemic. Public policies aiming to improve health and employment should be strategically designed to address the unique needs of urban and rural populations.

Sleep Disparities Across Pregnancy: A Michigan Cohort Study

Introduction

Poor sleep health during pregnancy is related to adverse pregnancy outcomes. This study aims to identify sociodemographic characteristics associated with sleep health during pregnancy and to examine how they relate to changes in sleep during pregnancy.

Materials and Methods

Participants (n = 458) were from the Michigan Archive for Research on Child Health, which is a prospective pregnancy cohort. Sociodemographic characteristics and self-reported sleep timing and quality were collected in phone interviews. This longitudinal study collected sleep parameters once during the early trimesters and once during the third trimester. Fall asleep and wake-up times were used to calculate sleep duration and sleep midpoint.

Results

Compared to the third trimester, sleep duration was 12 minutes longer (p = 0.02), fall asleep time was 21 minutes earlier (p < 0.001), and the midpoint of sleep was 12 minutes earlier (p = 0.01) in early trimesters. Shorter sleep duration was noted in younger women. Sleep midpoint was later in those who were younger, overweight, or obese, racial minorities, unmarried, and with lower educational levels or socioeconomic status, and who smoked before pregnancy after adjusting for covariates. After controlling for confounders, women who were not working for pay had higher likelihood of reduced sleep duration, and women who were unmarried were more likely to have a delayed sleep midpoint in the third trimester compared to the early trimesters.

Conclusions

This study suggests that sleep parameters changed during pregnancy and sleep health differed by sociodemographic characteristics. Understanding sleep disparities could help with early detection of at-risk populations during prenatal care.

Individual and neighborhood socioeconomic status and long-term individual trajectories of sleep duration among Black and White adults: the Southern Community Cohort Study

STUDY OBJECTIVES

Sleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults.

METHODS

This study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression.

RESULTS

Both Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups.

CONCLUSIONS

Lower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns.

A First Glimpse at the Latent Structure of Sleep Valuation Using a Sleep Valuation Item Bank

Introduction

Sleep valuation is the relative worth individuals place on sleep. Our prior study using a Sleep Valuation Item Bank (SVIB) showed that sleep valuation relates to age, gender, and health status. In this study, the psychometric properties of the SVIB and its latent factor structure were explored. We also investigated how sleep valuation factors relate to demographic, psychological, and sleep features.

Methods

Participants (N = 854) were recruited through TurkPRIME and completed a survey consisting of demographic, psychological, and sleep-related questions. The distributional properties of the SVIB items were quantified. Cronbach's alpha and correlation analyses were used to assess the internal consistency and test-retest reliability of SVIB items. Iterated principal factoring with a Promax rotation was used on the SVIB to explore its latent factor structure. Multiple regression analyses were used to investigate the variables associated with each factor.

Results

The factor analysis identified 29 items with factor loadings ≥0.4 on four major factors, tentatively called (1) sleep wanting, (2) sleep prioritizing, (3) sleep onset preference, and (4) sleep devaluation. While women had higher sleep wanting and lower sleep devaluation scores than men, they had lower sleep prioritizing. Older individuals tended to value sleep less but also devalued it less than younger participants. Finally, although both individuals with insomnia and depression devalued sleep, depressed individuals prioritized it more than those who were less depressed, while individuals with insomnia symptoms wanted sleep and preferred sleep onset more than those with less insomnia symptoms.

Discussion

The current SVIB captures broad dimensions of sleep valuation (wanting, prioritizing, preferring) and sleep devaluation. These broad dimensions had distinct patterns across person-level factors. Recognition of individual differences in sleep valuation may help target sleep health advocacy efforts and individualized treatment approaches, including for those with depression or insomnia.

Job loss and fetal growth restriction: identification of critical trimesters of exposure

PURPOSE

Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight.

METHODS

We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester.

RESULTS

Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference.

CONCLUSIONS

Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.

Chronic pain: Evidence from the national child development study

Using data from all those born in a single week in 1958 in Britain we track associations between short pain and chronic pain in mid-life (age 44) and subsequent health, wellbeing and labor market outcomes in later life. We focus on data taken at age 50 in 2008, when the Great Recession hit and then five years later at age 55 in 2013 and again at age 62 in 2021 during the Covid pandemic. We find those suffering both short-term and chronic pain at age 44 continue to report pain and poor general health in their 50s and 60s. However, the associations are much stronger for those with chronic pain. Furthermore, chronic pain at age 44 is associated with a range of poor mental health outcomes, pessimism about the future and joblessness at age 55 whereas short-duration pain at age 44 is not. Pain has strong predictive power for pain later in life: pain in childhood predicts pain in mid-life, even when one controls for pain in early adulthood. Pain appears to reflect other vulnerabilities as we find that chronic pain at age 44 predicts whether or not a respondent has Covid nearly twenty years later.

Global economic uncertainty and suicide: Worldwide evidence

Economic uncertainty is a driver of the business cycle. Its leading properties make it a key advanced indicator to assess the impact of socioeconomic factors on suicide for prevention purposes. This paper evaluates the effect of economic uncertainty on suicide rates worldwide. Uncertainty is gauged by a global economic policy uncertainty index. Suicide rates from 183 countries between 2000 and 2019 are matched to annual economic uncertainty, controlling for unemployment and economic growth in a fixed-effects panel model. Overall, the analysis suggests that increases in lagged economic uncertainty, as well as in unemployment and economic growth, may lead to an increased risk of suicide. When replicating the experiment for different regions of the world, the greatest impact of an increase in economic uncertainty can be found in Africa and the Middle East. Given the anticipatory nature of economic uncertainty regarding the evolution of economies, and its relationship with suicide rates, the results highlight the usefulness of uncertainty indicators as tools for the early detection of periods of increased suicide risk and the design of suicide prevention strategies.

The UK Coronavirus Job Retention Scheme and diet, physical activity, and sleep during the COVID-19 pandemic: evidence from eight longitudinal population surveys

BACKGROUND

In March 2020, the UK implemented the Coronavirus Job Retention Scheme (furlough) to minimise job losses. Our aim was to investigate associations between furlough and diet, physical activity, and sleep during the early stages of the COVID-19 pandemic.

METHODS

We analysed data on 25,092 participants aged 16-66 years from eight UK longitudinal studies. Changes in employment, including being furloughed, were based on employment status before and during the first lockdown. Health behaviours included fruit and vegetable consumption, physical activity, and sleep. Study-specific estimates obtained using modified Poisson regression, adjusting for socio-demographic characteristics and pre-pandemic health and health behaviours, were statistically pooled using random effects meta-analysis. Associations were also stratified by sex, age, and education.

RESULTS

Across studies, between 8 and 25% of participants were furloughed. Compared to those who remained working, furloughed workers were slightly less likely to be physically inactive (RR = 0.85; [95% CI 0.75-0.97]; I 2 = 59%) and did not differ overall with respect to low fruit and vegetable consumption or atypical sleep, although findings for sleep were heterogenous (I 2 = 85%). In stratified analyses, furlough was associated with lower fruit and vegetable consumption among males (RR = 1.11; [1.01-1.22]; I 2 = 0%) but not females (RR = 0.84; [0.68-1.04]; I 2 = 65%). Considering changes in quantity, furloughed workers were more likely than those who remained working to report increases in fruit and vegetable consumption, exercise, and hours of sleep.

CONCLUSIONS

Those furloughed exhibited similar health behaviours to those who remained in employment during the initial stages of the pandemic. There was little evidence to suggest that adoption of such social protection policies in the post-pandemic recovery period and during future economic crises had adverse effects on population health behaviours.

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

Importance

Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years.

Objective

To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US.

Design, Setting, and Participants

This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022.

Exposures

Self-reported race, ethnicity, household income, and sex.

Main Outcomes and Measures

Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age.

Results

The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age.

Conclusions and Relevance

The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.

Differences in Body Mass Index Trajectories and Their Classification, Sociodemographic Characteristics, and Health Behaviors between People with and without Disabilities Using Korea Health Panel Survey Data

A high body mass index (BMI) is an important factor that negatively affects the health of people with disabilities. In particular, since the high BMI has a cumulative effect on the occurrence of complications such as cardiovascular disease, it is required to investigate the data through longitudinal studies rather than cross-sectional studies. Therefore, we conducted a longitudinal follow-up study to examine the differences in the BMI trajectories of people in South Korea with disabilities, as well as the sociodemographic characteristics and health behaviors that classify individual trajectories into clusters. Participants aged 40 to 79 years who responded to the Korea Health Panel Survey (KHPS) from 2009 to 2018, 283 people with physical disabilities or brain lesion disorders, and 849 people without disabilities, were extracted. We found that the differences in the initial BMI between clusters were larger in 60-79-year-old people with disabilities (men 22.5 kg/m², 26.9 kg/m²; women 23.8 kg/m², 28.1 kg/m²) than in those without disabilities (men 22.1 kg/m², 23.3 kg/m²; women 24.8 kg/m², 25.6 kg/m²). Also, logistic regression analysis showed that, among the people with disabilities, women (OR = 1.94), those who lived alone (OR = 2.36), and those who were economically inactive (OR = 1.78) were more likely to be classified into the higher BMI category than those who were not. To effectively manage the BMI, it would be better to focus on women with disabilities, people with disabilities living alone, and people who are economically inactive.