Racial and Ethnic Differences in Sleep and Socioeconomic Status Among Cancer Survivors in the United States

BACKGROUND: Sleep problems are common among cancer survivors and are linked to poorer quality of life. In the general United States (US) population, socioeconomic status (SES) is strongly associated with sleep health, but emerging evidence suggests that these benefits may be diminished among non-White racial/ethnic groups. Whether such patterns extend to cancer survivors is unknown. METHODS: We analyzed data on 25,732 adult cancer survivors from National Health Interview Surveys. Sleep duration (normal 6-8 h; short ≤ 5 h; long ≥ 9 h) and troubled sleep (≥ 3 days/week of difficulty falling or staying asleep) were assessed via self-report. SES indicators included educational attainment and family income. Poisson regression models with race/ethnicity-by-SES interaction terms were used to estimate racial/ethnic differences in SES-sleep associations. RESULTS: Among non-Hispanic (NH) White survivors, higher education and income were consistently associated with lower prevalence of short sleep and troubled sleep. These SES gradients were muted or reversed among NH Black and Hispanic survivors. For example, NH White survivors with a bachelor's degree had substantially lower odds of short sleep compared with those with ≤ high school education, whereas no such association was observed among NH Black or Hispanic survivors. When stratifying by both education and income, income showed more consistent associations with sleep across all groups, while additional benefits of higher education were observed only among NH White survivors. CONCLUSIONS: SES-sleep gradients differ markedly across racial/ethnic groups among US cancer survivors. Tailored interventions addressing structural and socioeconomic inequities may be needed to improve sleep health and reduce disparities in survivorship.