Patterns of Sleep Inequities by Experiences and Recognition of Multiple Types of Discrimination Among Members of Three Urban Community Health Centers: The Life + Health Study (2020-2022).

Discrimination and unfair treatment are pervasive and contribute to population health inequities. This study examined how implicit and explicit measures of recognition of discrimination toward target vs. dominant groups, preference for target vs. dominant groups, and self-reported measures of experiences of discrimination are associated with sleep duration, disturbance, and impairment. Life + Health was a cross-sectional study that enrolled 699 participants ages 25-64 from three community health centers in Boston, MA between May 2020 and August 2022. We assessed implicit and explicit measures of six types of discrimination-racism, sexism, heterosexism, cissexism, ageism, and sizeism-and used regression-based modeling to assess crude and adjusted associations of measures with sleep outcomes. We found that target groups generally reported shorter sleep duration and worse sleep disturbance and impairment than dominant groups, though only shorter sleep duration among People of Color remained significant in adjusted models. Associations between implicit and explicit measures and sleep outcomes were largely attenuated after adjustment, though independent effects emerged for sexism among women in relation to sleep impairment. Findings highlight the complex relationships of recognition of discrimination and implicit preferences with sleep health and the importance of multidimensional approaches to measuring discrimination. Future longitudinal and larger sample population studies are needed to clarify mechanisms, consider intersectional identities and experiences, and identify intervention targets to advance sleep equity and population health. Our findings highlight the necessity of funding rigorous research on discrimination and health; defunding such research undermines scientific integrity, public health, and the goal of ensuring that all populations can thrive.