Social and Environmental Determinants of Health Equity

越来越多的证据表明，睡眠有助于心脏代谢疾病（如肥胖症，高血压，糖尿病，心血管疾病）的发病率和严重程度。我的目标是调查身体和社会环境的决定因素如何影响睡眠和心脏代谢健康之间的关系的种族，民族和社会经济差异。 睡眠和慢性病的决定因素 在过去，我和我的同事们研究了睡眠与肥胖、2型糖尿病（T2 DM）和心血管疾病（CVD）等健康状况之间的关系。我们已经表明，睡眠障碍在中年和老年人中普遍存在，并因种族/民族，性别和肥胖状况而异。我们还表明，少数种族/民族中睡眠障碍和未确诊的睡眠呼吸暂停的高患病率可能导致健康差异（Chen et al，2015; Chen et al，2016;杰克逊et al，2015）。由于我对肥胖的强烈兴趣与睡眠无关，我还研究了不同社会经济地位的肥胖趋势中的种族/民族差异（杰克逊等人，2016;杰克逊等人，2013）以及饮食（杰克逊et al，2015;杰克逊et al，2014）和体重指数（Tobias et al，2014; Global BMI Collaboration，2016;杰克逊et al，2014;杰克逊et al，2014;杰克逊et al，2014）对健康和死亡率的影响。我和同事最近报告（2017财年，2016年10月至2017年）睡眠时间与2型糖尿病风险之间存在U型关系，每天睡眠时间为7-8小时时，2型糖尿病风险最低（Shan et al，2016）。我们还报告了睡眠困难与T2 DM风险增加相关，与其他CVD风险因素无关（Li et al，2016）。我现在正在使用NIEHS姐妹篇研究、多种族动脉粥样硬化研究和杰克逊心脏研究的数据，调查睡眠健康和随后的心脏代谢功能障碍风险中种族/民族和社会经济差异的决定因素。事实上，我正在完成一项研究，调查白人，黑人，拉丁美洲人和中国多种族动脉粥样硬化研究参与者之间睡眠时间的主观和客观测量之间的一致性/协议，以确定报告偏倚是否因种族而异。我和同事们还提交了一份关于工作中感知到的不平等、感知到的不平等对家庭的负面溢出以及随之而来的失眠风险的调查报告。 由于对确定导致睡眠健康差异的上游环境因素的浓厚兴趣，我还开发了一个混合方法项目，以调查种族的工作-睡眠关系，并正在研究物理环境中的因素的影响，如住房条件可能导致睡眠差异。自2017年1月在NIEHS开始以来，我的研究结果已在多个睡眠相关和流行病学科学会议上发表，包括美国睡眠医学学会和睡眠研究学会以及流行病学研究学会的联席会议。

Growing evidence suggests that sleep contributes to the incidence and severity of cardiometabolic conditions (e.g. obesity, hypertension, diabetes, cardiovascular disease). My objective is to investigate how physical and social environmental determinants impact racial, ethnic, and socioeconomic disparities in the relationship between sleep and cardiometabolic health. Determinants of Sleep and Chronic Disease In the past, colleagues and I have investigated associations between sleep and health conditions like obesity, type 2 diabetes (T2DM), and cardiovascular disease (CVD). We have shown that sleep disturbances are prevalent among middle-aged and older adults, and vary by race/ethnicity, sex, and obesity status. We have also shown that the high prevalence of sleep disturbances and undiagnosed sleep apnea among racial/ethnic minorities may contribute to health disparities (Chen et al, 2015; Chen et al, 2016; Jackson et al, 2015). Because of my strong interest in obesity independent of its relationship with sleep, I have also studied racial/ethnic disparities in obesity trends by socioeconomic status (Jackson et al, 2016; Jackson et al, 2013) as well as dietary (Jackson et al, 2015; Jackson et al, 2014) and body mass index (Tobias et al, 2014; Global BMI Collaboration, 2016; Jackson et al, 2014; Jackson et al, 2014; Jackson et al, 2014) influences on health and mortality. Colleagues and I have most recently reported (FY 2017 October 2016-2017) a U-shaped relationship between sleep duration and risk of type 2 diabetes with the lowest type 2 diabetes risk at 7-8 hours per day of sleep duration (Shan et al, 2016). We have also reported that sleeping difficulty is associated with an increased risk of T2DM, independent of other CVD risk factors (Li et al, 2016). I am now using data from the NIEHS Sisters Study, Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study to investigate determinants of racial/ethnic and socioeconomic disparities in sleep health and subsequent risk of cardiometabolic dysfunction. In fact, I am finalizing a study investigating the concordance/agreement between subjective and objective measures of sleep duration among Whites, Blacks, Latinos, and Chinese participants of the Multi-Ethnic Study of Atherosclerosis to determine if reporting bias differs importantly by race. Colleagues and I have also submitted for publication an investigation of perceived inequality at work, negative spillover into the home from the perceived inequality, and subsequent risk of insomnia. Because of a strong interest in identifying upstream environmental factors that contribute to sleep health disparities, I am also developing a mixed methods project to investigate the work-sleep relationship by race and am studying the impact of factors in the physical environment like housing conditions that may contribute to disparities in sleep. Since starting at NIEHS in January 2017, my research findings have been presented at several sleep-related and epidemiological scientific conferences, including the Joint Meeting of the American Academy of Sleep Medicine and the Sleep Research Society as well as the Society for Epidemiologic Research.