0303 Associations Between Social Determinants of Health and Long-term Fitbit-Measured Sleep Duration and Variability in the All of Us Research Program

Abstract Introduction Prior research on sleep and social determinants of health (SDOH) has largely relied on subjective sleep measures (primarily self-reported sleep duration) or short-term actigraphy recordings. Evidence remains limited on the associations between SDOH and objectively-assessed long-term sleep patterns in large-scale populations. Methods Our study included 13,282 participants from the All of US Research Program, who contributed at least 6 months of Fitbit data (mean 1247 days, range 181-4174). Mean sleep duration (in minutes) and sleep duration standard deviation (SD) across all available days were calculated from main sleep episodes, excluding days with sleep durations < 180 or >840 minutes. SDOH measures, including social/community context (e.g., social support), economic stability, neighborhood and built environment, and healthcare access and quality, were derived from validated surveys. To facilitate comparisons, overall and domain-specific SDOH scores were standardized to z-scores. Associations between sleep metrics and SDOH (overall and by domains) were examined using multiple linear regression, adjusting for demographic, socioeconomic, and behavioral factors. Results The analytical sample had a mean age of 58.9 years (SD: 15.2); 70.3% were female, 84.2% were reported as white, and 59.6% were below the highest education category, with a mean sleep duration of 409.5 min (SD: 40.8). A 1-SD increase in the overall SDOH score, indicating more favorable social and structural conditions, was associated with 6.0 minutes (95% CI: 3.4, 8.7) longer sleep duration and 3.6 minutes (95% CI: –4.8, –2.4) lower sleep duration SD. Across individual domains, social/community context showed the strongest associations, with a 1-SD increase in the domain-specific score associated with 4.8 minutes (95% CI: 2.6, 7.0) longer sleep duration and 3.4 (95% CI: –4.4, –2.4) minutes lower sleep duration SD. Economic stability showed similar associations, while health and healthcare demonstrated slightly weaker associations (p< 0.04). No significant associations were observed for the neighborhood environment domain. Conclusion More favorable SDOH conditions, including social/community context, economic stability, and healthcare access, were associated with modestly longer and more regular sleep duration, emphasizing the importance of social context in sleep health. Ongoing analyses are investigating potential heterogeneity in these associations across age groups, sex, and race/ethnicity. Support (if any) NIA Intramural Research Project ZIAAG000530