Social determinants of health and sleep duration among U.S. adults: insights from NHANES 2005-2018.

Purpose: Social determinants of health (SDoH) influence sleep duration, but their independent and combined effects on short and long sleep are not well understood.

Methods: We analyzed 31,223 adults from NHANES 2005-2018. Sleep duration was categorized as short (< 7 h), recommended (7-9 h), and long (> 9 h). Eight SDoH indicators were included, representing economic stability (employment status, family poverty income ratio, food security), education (educational attainment), healthcare access (healthcare access, insurance coverage), housing stability, and social context (marital status). Survey-weighted logistic regression assessed associations, adjusting sequentially for other SDoH, demographic, lifestyle, and clinical factors. Weighted quantile sum (WQS) regression evaluated cumulative SDoH effects and relative contributions.

Results: Lower education, marital disruption, and low food security were associated with short sleep. In contrast, low income, never married or widowed, lower education, unemployment, very low food security, and government insurance were associated with long sleep. WQS analysis demonstrated a cumulative association between SDoH burden and sleep duration, with each quartile increase in the SDoH index associated with higher odds of short sleep (OR = 1.93, 95% CI: 1.69-2.20) and long sleep (OR = 3.82, 95% CI: 3.15-4.66). The leading contributors identified by WQS were food security and marital status for short sleep, and poverty-income ratio (PIR) and educational attainment for long sleep.

Conclusions: Multiple SDoH independently and jointly influence sleep duration, highlighting the need for multi-level interventions to improve sleep duration in socioeconomically disadvantaged populations.

Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s41105-026-00671-7.