Rurality And Socioeconomic Status Are Associated With Sleep Parameters During Pregnancy

In adult populations, individuals with lower socioeconomic status tend to have poorer sleep than those with higher socioeconomic status. Differences in sleep in rural vs. urban populations is unclear. Less is known about sleep differences across socioeconomic status and rurality during pregnancy. PURPOSE: To determine if there are differences in self-reported sleep parameters by rurality and socioeconomic status during pregnancy. METHODS: Data from 454 participants, mean age 30.8 (4.4) years, 89% White, from the Pregnancy 24/7 multi-site cohort study were used. Sleep parameters were measured in each trimester of pregnancy with the Pittsburgh Sleep Quality Index (PSQI). Parameters included duration (hr), global PSQI score (0-21 points), disturbances factor (disturbances + daytime dysfunction, 0-6), efficiency factor (duration + efficiency, 0-6), and perceived quality factor (subjective sleep quality + latency + medication use, 0-9). Higher sleep scores indicate greater sleep disturbances. Rurality was determined by Rural Urban Commuting Area Code (0-3 = Urban, 4-6 = Micropolitan, 7-10 = Rural). Socioeconomic status was measured by education level, income tertiles, and insurance status. Analyses were conducted in R using a repeated measures mixed effects model while adjusting for study site, children in the household, age, and pre-pregnancy BMI. RESULTS: All sleep parameters, except duration, tended to be worse in rural populations and in those with lower socioeconomic status compared to those from urban areas and with higher socioeconomic status, respectively (Table 1). CONCLUSION: Strategies to improve rural and socioeconomic disparities in sleep health during pregnancy are needed and could help to address overarching maternal health disparities in these communities. - Table 1. Associations of Rurality and Socioeconomic Status with Sleep Across Pregnancy. Group Duration p Global PSQI p Disturbances Factor p Efficiency Factor p. Quality Factor p Rurality Urban 7.33 (0.05) Ref 6.11 (0.14) Ref 2.59 (0.04) Ref 0.99 (0.06) Ref 2.52 (0.08) Ref Micropolitan Rural 7.20 (0.16) 0.74 6.40 (0.42) 0.79 2.63 (0.14) 0.97 1.27 (0.18) 0.33 2.50 (0.24) 1.00 Small Town Rural 7.11 (0.13) 0.23 7.18 (0.33) 0.01 2.68 (0.11) 0.68 1.35 (0.14) 0.06 3.15 (0.19) 0.01 Education Post-baccalaureate 7.39 (0.07) Ref 5.67 (0.18) Ref 2.49 (0.06) Ref 0.83 (0.08) Ref 2.35 (0.10) Ref Baccalaureate 7.20 (0.08) 0.14 6.76 (0.20) <.001 2.71 (0.06) 0.02 1.24 (0.08) <.001 2.80 (0.11) 0.01 Pre-baccalaureate 7.25 (0.10) 0.52 6.66 (0.27) 0.01 2.66 (0.09) 0.26 1.26 (0.12) 0.01 2.74 (0.15) 0.11 Income High 7.40 (0.09) Ref 5.33 (0.22) Ref 2.35 (0.07) Ref 0.79 (0.10) Ref 2.19 (0.13) Ref Middle 7.27 (0.08) 0.50 6.06 (0.21) 0.04 2.59 (0.07) 0.03 1.04 (0.09) 0.14 2.43 (0.12) 0.34 Low 7.24 (0.07) 0.31 6.84 (0.18) <.001 2.76 (0.06) <.001 1.22 (0.08) <.001 2.86 (0.10) <.001 Insurance Private 7.30 (0.05) Ref 6.11 (0.13) Ref 2.56 (0.04) Ref 1.02 (0.06) Ref 2.53 (0.08) Ref Medicaid/Medicare 7.26 (0.13) 0.77 7.03 (0.33) 0.01 2.82 (0.10) 0.02 1.29 (0.14) 0.08 2.91 (0.19) 0.07 All values are expressed as mean estimates (standard error). Duration is measured in hours. Global PSQI is a composite score of seven PSQI components (range: 0-21). Higher scores indicate increasingly severe sleep difficulties. Disturbances factor is the sum of disturbances and daytime dysfunction components (0-6). Efficiency factor is the sum of efficiency and duration components (0-6). Quality factor is the sum of subjective sleep quality, latency, and medications components (0-9). Bold results are significant (<.05) compared to the reference group. High income: $200,000 or more, Middle income: $100,000 - $149,999; Low income: $50,000 or less.