Social and Environmental Determinants of Health Equity

越来越多的证据表明，睡眠导致心脏代谢性疾病(如肥胖、高血压、糖尿病、心血管疾病)的发生率和严重程度。我的目标是调查生理和社会环境决定因素如何影响睡眠和心脏代谢健康关系中的种族、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，睡眠障碍在中老年人中很普遍，并因种族/民族、性别和肥胖状况而异。我们还表明，在种族/少数民族中睡眠障碍和未诊断的睡眠呼吸暂停的高流行率可能导致健康差异(Chen等人，2015；Chen等人，2016；Jackson等人，2015)。由于我对肥胖与睡眠无关的浓厚兴趣，我也研究了肥胖趋势中的种族/民族差异，按社会经济地位(Jackson等人，2016；Jackson等人，2013)以及饮食(Jackson等人，2015；Jackson等人，2014)和身体质量指数(Tobias等人，2014；Global BMI Collaboration，2016；Jackson等人，2014；Jackson等人，2014)对健康和死亡率的影响进行了研究。我和同事们最近(2017财年10月至2017财年)报告了睡眠时间与2型糖尿病风险之间的U型关系，每天睡眠时间为7-8小时的2型糖尿病风险最低(Single等人，2016)。我们还报告了睡眠困难与T2 DM风险增加相关，独立于其他心血管疾病危险因素(Li等人，2016)。我现在使用NIEHS姐妹研究、动脉粥样硬化多种族研究和杰克逊心脏研究的数据来调查睡眠健康中种族/民族和社会经济差异的决定因素，以及随后的心脏代谢功能障碍风险。事实上，我正在完成一项研究，调查白人、黑人、拉丁裔和中国人参与动脉粥样硬化多种族研究的主观和客观睡眠时间指标之间的一致性/一致性，以确定报告的偏见是否因种族而有重要差异。我和同事们还提交了一份关于工作中感受到的不平等、感受到的不平等对家庭的负面溢出以及随后的失眠风险的调查报告。由于对识别导致睡眠健康差异的上游环境因素有着浓厚的兴趣，我还在开发一个混合方法项目，通过种族来调查工作和睡眠的关系，并研究物理环境中可能导致睡眠差异的因素的影响，比如住房条件。自2017年1月在NIEHS开始工作以来，我的研究成果已经在几次与睡眠相关的和流行病学的科学会议上发表，包括美国睡眠医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.