Sleep duration associated with acute care utilization: Revisiting Andersen’s Behavioral Model of Health Services Use

Andersen's Behavioral Model of Health Services Use explains healthcare utilization through three key domains-health needs, predisposing characteristics, and enabling resources-that influence whether individuals access medical care. This study examined whether self-reported sleep duration, as a health needs factor, is associated with acute care hospital utilization in the United States. We analyzed data from 30,122 civilians ages 18+ from the 2020 National Health Interview Survey. Acute care utilization included past-year emergency room visits and overnight hospitalizations. Zero-inflated negative binomial and multivariable logistic regression models were used to assess associations of health needs, predisposing, and enabling factors with acute care utilization. Eight in 10 adults had no emergency room visits (81.1%), while 12.3% had one visit, 4.3% had two, 1.1% had three, 1.2% had 4+ visits, and 8.4% experienced overnight hospitalization. Sixty-four percent reported healthy sleep. Very short and long sleep were associated with significantly higher emergency room visit rates, while very short, short, and long sleep were associated with greater odds of overnight hospitalization compared with healthy sleep. Poor or fair health and multiple chronic conditions were also associated with increased acute care use. Predisposing (e.g., ages 18-44, female sex, Black race, and place of birth) and enabling factors (e.g., financial hardship, health insurance) further contributed to greater utilization. Sleep duration is a significant and underexamined health needs factor in acute care utilization. Improving sleep health may help reduce the frequency of emergency room visits and hospitalizations. Future studies should explore the directionality of these associations and examine other sleep dimensions in relation to acute care utilization.