0322 Psychosocial Adversity Is a Contributor to Racial Disparities in Sleep Health in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract Introduction Black Americans experience disproportionately poor sleep health, yet the mechanisms underlying these disparities remain incompletely understood. Psychosocial adversity throughout the life course including discrimination, chronic stress, and early life adversity (ELA) is linked to sleep health and may explain racial disparities in sleep. This study evaluated whether psychosocial adversities individually and cumulatively explained Black–White disparities in a composite measure of multidimensional sleep health in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods We analyzed 1,391 Black and White adults from the MESA-Sleep Study (2010–2013). Sleep health scores (SHS) (range: 0–9) were derived from 7-day actigraphy and questionnaires. Psychosocial adversities included lifetime and everyday discrimination, chronic stress burden, and ELA. A cumulative lifetime adversity (CLA) score was created as the mean of percent-of-maximum-possible (POMP)-standardized domains (range: 0-100 index; higher scores indicate greater cumulative adversity). Counterfactual disparity measure (CDM) analyses with marginal structural models with inverse probability weighting estimated the proportion of the Black-White SHS disparity attributable to psychosocial adversities, individually and cumulatively. The CDM analyses compared the observed disparity with the disparity expected if adversity levels were set to a fixed values (none [0%] or average [≤17%]) for both racial groups. Results Black participants had lower SHS than White participants (mean [SD]: 4.6 [1.4] vs 5.6 [1.7]) and greater exposure to discrimination, chronic stress, and higher CLA scores. Discrimination and chronic stress burden were associated lower SHS after adjustment for sociodemographics, while ELA was not. CDM analyses indicated that individual psychosocial adversities did not explain Black-White disparities in SHS. In contrast, CLA accounted for 6.2% (95% CI: 2.2%, 11.0%) of the disparity when CLA was set to the overall sample average and 2.4% (95% CI: 0.0%, 4.0%) when adversity was set to none. Conclusion Cumulative psychosocial adversity, but not the individual components contributed to Black–White disparities in SHS. These findings highlight the contribution of clustering of multiple adversities across the life course to racial disparities in sleep. However, eliminating these disparities will require addressing systematic determinants of sleep, including social and physical environmental conditions, alongside to strengthening resilience among populations most burdened by psychosocial adversity. Support (if any) 5T32HL130025-09 Laney Graduate School at Emory University ARCS Foundation Atlanta