Does the demography of sleep contribute to pre-existing health disparities?
The aim of this chapter is to incorporate the extensive and growing literature on health disparities into the discourse on sleep disorders and public health. The population health literature, quite distinct from the sleep research literature, describes the relationships between various sociodemographic characteristics and health. It describes how people with greater wealth exhibit, on average, greater health, and how this relationship persists even when controlling for health behaviors and pre-existing health conditions.1-3 A life expectancy advantage is also observed for women over men, Whites over Blacks, highly educated people over less educated people, married people over unmarried people, and, of course, young people over old people.1,4,5 The existence of these social and racial health differences has inspired a broad interdisciplinary research agenda that seeks to identify the sources of these health inequalities and ways to improve the health of the worse-off populations. Thus far, the research has discussed how factors such as early life conditions, health behaviors, wear and tear on the body (sometimes referred to as allostatic load), and health care utilization are relevant and active forces in determining the health of any given community or population.4,6-8 In this chapter, we contribute to the population health discussion by
investigating whether sleep disorders and sleep behaviors are contributing to (or ameliorating) these health disparities.