A cross-national study examining social determinant factors on short sleep between the U.S. and Canada

Sleep is essential for optimal health as short sleep is associated with cardiovascular disease, diabetes, and early mortality. One-third of adults in the U.S. and Canada do not receive sufficient sleep. Canadian adults are typically healthier than U.S. adults and inequities in sleep may be a critical factor which may account for cross-national differences in health. Sleep is also patterned by social determinant factors; however, limited research examines which social determinant factors are associated with short sleep patterns between the U.S. and Canada. Our study begins to address this underdeveloped area of research.

We used two nationally representative cross-sectional data sources in the U.S. (National Health Interview Survey or NHIS; N = 47,945) and Canada (Canadian Community Health Survey or CCHS; N = 41,468) to examine social determinant factors (age, race/ethnicity, education, income, marital status, living with children) and short sleep. We estimated log-binomial regression models, stratified by sex.

In 2016-2017, about one third of adults in the NHIS and one half of adults in the CCHS reported short sleep. Among adults in the NHIS, respondents aged 45-64 years, race/ethnicity (Black, Other, and Hispanic/Latinx adults among females only), having low-income status, unmarried, and living with children, were all associated with short sleep. These factors were also associated with short sleep among adults in the CCHS; however, these relationships were more attenuated. The prevalence for short sleep was higher across all factors by sex among adults in the NHIS than in the CCHS dataset, with the exception of non-White female adults in Canada.

The role of social determinant factors may be more attenuated for short sleep among adults in Canada than in the U.S. potentially due to a more generous social welfare system and also a publicly funded healthcare system. Additional investigations are needed to examine short sleep inequities across the U.S. and Canada.