0311 Psychosocial and Environmental Determinants of Objectively Measured Insufficient Sleep and Cardiometabolic Risk in Black Adults: A Mediation Analysis

Abstract Introduction Insufficient sleep (IS) is a well-established risk factor for adverse cardiometabolic outcomes that disproportionately affect Black Adults (BA). However, the extent to which psychosocial and neighborhood factors contribute to sleep duration among BA, and whether sleep duration helps explain cardiometabolic risk (CMR), remains unclear. We examined (1) associations of psychosocial and environmental determinants (PEDs) with CMR, (2) associations between PEDs and IS, and (3) whether IS mediates these relationships. Methods We analyzed cross-sectional data from 275 BA (73% female; Mage= 40.8, SD= 12.5 [range 18–75 years]) residing in New York and Miami from the NIH-funded ESSENTIAL study. Participants completed one week of home-based monitoring with the SleepImage Ring; nightly sleep duration was averaged to calculate IS. Psychosocial determinants included discrimination (Everyday Discrimination Scale), life stressors (Holmes and Rahe Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and mental health (SF-12, history of anxiety/depression diagnosis). Environmental determinants included the Neighborhood Environment Walkability Scale (e.g., residential density, street connectivity), the Assessment of Sleep Environment, and neighborhood noise (SoundScore). CMR included a history of cardiometabolic risk diagnosis. Covariates included age, gender, education, employment, marital status, religious affiliation, income, and location. Unadjusted and adjusted linear and multivariable regression models identified independent associations of PEDs with IS and CMR. Mediation analyses for key PEDs estimated the indirect or direct effects on CMR. Results In fully adjusted models, greater overall social support (β= 0.20, p = 0.005), higher residential density (β= 0.0017, p= 0.012) and greater street connectivity (β= 0.33, p= 0.015) were associated with ​​longer sleep duration. Psychosocial and neighborhood factors exhibited modest associations with CMR. Across all exposure–outcome pairs, estimated indirect effects via sleep duration were small and not statistically significant. Conclusion Results suggest perceived social support and neighborhood environment were strongly associated with IS. However, objectively measured sleep duration did not mediate the associations between these factors and CMR. This suggests that pathways linking social and neighborhood context to CMR may operate largely through mechanisms other than IS, warranting the need for future longitudinal studies to explore these relationships further. Support (if any) National Institutes of Health R01HL142066