Association of road traffic accident with sleep disturbances among Indian population aged 45 years and above: nested multilevel modelling analysis of nationally representative cross-sectional survey

Road traffic accidents (RTA) are the leading cause of death worldwide. Sleep deprivation is one of the common human factors associated with RTA. Our study aimed to estimate the relationship between RTA and sleep disturbances stratified by gender and age group; and to determine the states and union territory wise distribution of Indian participants. Longitudinal ageing study in India (LASI) is an ongoing cohort study to collect information on health aspects of ageing in India. Current study is conducted using 1st wave of LASI data set (April 2017 to December 2018). Sleep disturbance was assessed using the Jenkin sleep scale (JSS-4). It covers four sleep related questions in last one month and participants were classified as presence or absence of sleep disturbance. We have documented the association of RTA (outcome variable) with sleep disturbance (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. To assess the association between sleep disturbances and road traffic accidents (RTAs), we employed multilevel logistic regression models, accounting for clustering at the state level to adjust for hierarchical data structure. This approach allowed us to examine individual-level predictors while considering contextual differences across states. States and union territories were categorised and cross tabulated as low, middle and high as per RTA and sleep disturbance. P value < 0.05 was considered statistically significant. Stata version 17 was used for analysis. Eligible participants were 66,383 out of total 73,396. Prevalence of RTA in participants more than 45 years was 1.85%. Prevalence was estimated higher in age group 45–59 years (2.20%) compared with more than 60 years (1.46%). Presence of sleep disturbance is significantly associated with RTA (AOR 1.84, 95% CI (1.58–2.14)). Male with sleep disturbance had higher odds of RTA (AOR 2.17, 95% CI (1.81–2.60)) compared with females (AOR 1.32, 95% CI (1.01–1.74)). Participants aged 45–59 years had higher odds of RTA (AOR 1.93, 95% CI (1.58–2.35)). High prevalence of both RTA and sleep disturbance were reported in Punjab, Uttar Pradesh, West Bengal, Kerala, Madhya Pradesh, Uttarakhand. Presence of sleep disturbance is significantly associated with road traffic accidents. Also, male and participants aged 45–59 years had higher risk. Effective policy making and better primary health care approach needs to be formulated and implemented to deal with these important public health conditions.