Social determinants of health and objective rest-activity rhythms and sleep health in U.S. Adults: Depression and overactive bladder as potential explanatory factors.

This cross-sectional study examined whether cumulative adverse social determinants of health (SDOH) were associated with accelerometer-derived rest-activity rhythms and multidimensional sleep metrics, and whether depression and overactive bladder statistically accounted for part of the SDOH-relative amplitude association in exploratory pathway analyses. We analyzed 6,130 U.S. adults aged 20-80 y (mean age 49.5 y; 51.7% female) from NHANES 2011-2014. From wrist-worn 7-d accelerometer recordings, nonparametric rest-activity indices (interdaily stability, intradaily variability, and relative amplitude) and sleep parameters (duration, efficiency, timing irregularity, social jetlag, and catch-up sleep) were derived. A composite SDOH score (0-8) was constructed across economic, educational, healthcare, housing, and social domains. In fully adjusted survey-weighted linear regression, each 1-unit higher SDOH score was associated with lower relative amplitude (beta = -0.007; 95% CI, -0.008 to -0.005), greater rhythm fragmentation, shorter sleep duration, lower sleep efficiency, and more irregular sleep timing. Graded associations were observed across SDOH quartiles. At the component level, unpartnered status, unemployment, and food insecurity showed the most consistent inverse associations with rhythm robustness. Exploratory pathway analyses were consistent with small indirect associations through depression severity and overactive bladder. Overall, greater cumulative adverse SDOH burden was associated with less robust, more fragmented rest-activity rhythms and poorer multidimensional sleep health.