Social Determinants of Health and Long-Term, Device-Based Sleep Health

Importance Prior research on social determinants of health (SDOH) and sleep health has largely relied on subjective sleep measures, primarily self-reported sleep duration. Evidence remains limited on the associations between SDOH and wearable-derived long-term sleep patterns in large-scale populations. Objective To examine how SDOH (overall and by domain) are associated with long-term, wearable-derived sleep duration and variability. Design, Setting, and Participants This cross-sectional study included participants from the All of Us Research Program enrolled between 2018 and 2023 who contributed at least 180 days of wearable data, including pre-enrollment historical records, and completed the SDOH survey. Data analysis was conducted from September 2025 to June 2026. Exposures Measures of overall and domain-specific SDOH, including social and community context, economic stability, neighborhood environment, and health care access and quality, were derived from validated surveys and standardized to z scores. Main Outcomes and Measures Mean daily sleep duration (in minutes) and day-to-day sleep duration SD across all available days were calculated from device-estimated main sleep episodes. Results Among 12 403 participants (mean [SD] age, 57.8 [15.2] years; 8719 female [70.3%]; 10 946 White [88.3%] and 1457 members of minority racial groups [11.7%]; 756 Hispanic [6.1%]), 9052 individuals (73.0%) had a college degree or above, with a mean (SD) sleep duration of 406.1 (44.9) minutes and a mean (SD) sleep duration SD of 76.9 (20.6) minutes. Participants were monitored for a median (range) of 982 (180 to 4133) days. Compared with participants in the lowest SDOH tertile, those in the highest tertile (indicating more favorable social and structural conditions) had 5.82 minutes (95% CI, 3.84 to 7.80 minutes) longer sleep duration and 4.79 minutes (95% CI, −5.69 to −3.89 minutes) lower sleep duration SD in the fully adjusted model. When examining individual SDOH domains, economic stability showed the strongest associations with mean sleep duration (eg, 10.70 minutes; 95% CI, 5.30 to 16.10 minutes) and sleep duration SD (eg, −8.70 minutes; 95% CI, −11.20 to −6.26 minutes). Limited subgroup heterogeneity in the association was observed across age, sex, race, and ethnicity. Conclusions and Relevance In this study, more favorable SDOH conditions were associated with longer and more regular habitual sleep duration over the long term, emphasizing the importance of social and structural factors when evaluating sleep health.