Insufficient Sleep Correlates with the Natural Environment, Health Behaviors, and Selected Causes of Death
Author(s):
Ray M Merrill
Objective: To estimate the prevalence of insufficient sleep in the contiguous US and show how insufficient sleep correlates with selected natural environment factors, health behaviors, and causes of death.
Design: An ecologic study design was used with measurements for each variable on the county level. Setting: A total of 3,108 counties in the contiguous US.
Measures: Measurements were on the county level, which included altitude, sunlight, ambient air temperature, PM2.5, and precipitation, and selected health behaviors and causes of death.
Results: Higher altitude is associated with better sleep, but this association is explained by lower average daily fine particulate matter, maximum air temperature, and precipitation at higher altitude. Improved sleep duration correlates with less air pollution, moderate sleeping temperatures, and less precipitation, which likely correlates with better health behaviors. Sufficient sleep may further improve by lower tobacco smoking, obesity, physical inactivity, and better diet. After accounting for the environmental and health behavior variables, insufficient sleep no longer had a direct effect on the causes of death, except for injury and motor vehicle accidents.
Conclusions: Better sleep duration occurs at lower altitude and in places where there is less average daily fine particulate matter, more moderate maximum air temperature, and lower precipitation. Better sleep duration also correlates with less tobacco smoking, obesity and physical inactivity, and better diet. After accounting for the environmental and health behavior variables, insufficient sleep continues to have a direct influence on death, except rates associated with injury and motor vehicle accidents.