Wzorzec-przegl d lekarski-XX-2001

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£ Table I Proportion reporting poor sleep on 4 or more nights a week by demographic and socio-economic variables by gender, age 16-74 Men Women Total % n = % N = % n= All 14. 2 3851 19. 7 4727 17. 2 8578 Age 16-24 10. 9 385 15. 9 409 13. 5 794 25-34 12. 9 711 15. 7 972 14. 6 1683 35-44 13. 2 823 17. 5 1024 15. 6 1847 45-54 15. 1 747 24. 2 798 19. 8 1545 55-64 16. 7 646 22. 0 796 19. 6 1442 65-74 15. 4 539 22. 9 728 19. 7 1267 p= 0.091 0.000 0.000 Marital Status Married 12. 5 2356 18. 0 2739 15. 5 5095 Single 12. 4 937 15. 8 849 14. 0 1786 Widowed 21. 4 131 25. 9 432 24. 9 563 Divorced/Separated 25. 5 427 27. 2 707 26. 5 1134 p= 0.000 0.000 0.000 Number of children No children 15. 2 2816 20. 4 3096 17. 9 5912 1 child 13. 2 440 19. 1 650 16. 7 1090 2 children 9. 3 454 18. 5 701 14. 9 1155 3+ children 13. 5 141 16. 4 280 15. 4 421 p= 0.008 0.303 0.055 Highest Educational Qualifications Degree 9. 4 662 14. 7 577 11. 9 1239 Professional, A Level 10. 7 857 17. 2 886 14. 0 1743 GCSE or equivalent 15.2 1 2 1248 17. 9 1719 16. 8 2967 No qualifications 18. 7 1047 25. 1 1517 22. 5 2564 p= 0.000 0.000 0.000 Employment Status Working full time 10. 2 2353 14. 5 1463 11. 8 3816 Working part time 11. 6 285 16. 0 1168 15. 1 1453 Unemployed 20. 5 146 24. 6 114 22. 3 260 Economically inactive 23. 1 1031 25. 5 1954 24. 7 2985 p= 0.000 0.000 0.000 Household Equivalised Income per week L£ < L150 £ 24. 9 574 25. 7 1082 25. 4 1656 £ L150
Table II Proportion reporting poor sleep on 4 or more nights a week by smoking, worries and health variables by gender, age 16-74 Men Women Total % n= % n= % n= Cigarette Smoking Current Smoker 19.0 1162 24.4 1402 22.0 2564 Ex Smoker 12.0 1808 18.3 1938 15.3 3746 Never Smoked 12.3 877 16.8 1383 15.0 2260 p= 0.000 0.000 0.000 Self-reported Worries No 9.3 2612 12.5 2888 11.0 5500 Medium 14.6 591 22.2 825 19.0 1416 High 33.6 648 38.4 1014 36.5 1662 p= 0.000 0.000 0.000 Health worries No 10.0 3228 15.3 3909 12.9 7137 Medium 28.4 342 33.7 466 31.4 808 High 45.6 281 49.7 352 47.9 633 p= 0.000 0.000 0.000 Self-reported Health Very Good or Excellent 7.0 2111 12.3 2473 9.8 4584 Good 13.4 972 20.4 1253 17.3 2225 Fair or poor 35.1 767 37.4 999 36.4 1766 p= 0.000 0.000 0.000 Number of chronic illnesses 0 8.3 2108 12.7 2442 10.7 4550 1 16.7 1099 21.4 1296 19.2 2395 2 22.0 381 28.7 575 26.0 956 3 or more 40.0 260 44.0 411 42.5 671 p= 0.000 0.000 0.000 Source: Psychiatric Morbidity Survey, 2000 (authors' analysis) Worries are implicated in the gender difference in sleep problems. Women's sleep is more likely to be disturbed by worries, particularly associated with their gender role as mothers or wives, and their concern for the well-being of family members [13, 2, 31]. Previous sleep research has tended to view 'worries' as a mark of anxiety or psychological problems, rather than embedded within social roles and responsibilities. Worries and concerns represent an important predictor of sleep problems, but retain an independent effect after controlling for health and depression Table III, Model 5). In addition, this analysis suggests that differences in health status between men and women do not explain the gender difference in sleep problems. Indeed, the gender difference becomes greater after adjusting for health variables and depression (Table III, Model 5). This research supports other studies that have found poorer sleep quality among those with low educational qualifications [15, 21, 24, 29], who are not working [22, 24], and have low income [17, 9]. However, this study goes beyond previous research in two ways. First, by using representative national data to simultaneously consider the independent effects of four SES variables (education, employment status, household income, housing tenure). Second, it addresses previous observations [24] that the higher prevalence of insomnia among individuals with low education, not working and with low income may be confounded by poor physical and mental health, through examining models containing health measures and depression. The relative importance of different sets of factors in leading to sleep problems are considered. 'Worries' are likely to be confounded with socio-economic characteristics; the relationships between sleep problems and living on a low income or living in rented housing were partially mediated through worries and concerns. After adjusting for smoking, worries, health and depression, a significant independent association still remained between sleep problems and both low education and not being in paid work. Lack of employment is linked to sleep problems in two ways; for the unemployed, primarily through its intrinsic relationship with worries, while for the economically inactive, primarily because of their poorer health status. There is a much larger effect of marital status on sleep problems among men than among women, suggesting advantages conferred by marriage for men in terms of sleep quality. Divorced/separated men and widowed men have particularly poor quality sleep compared with married men. Although losing a partner (whether through divorce or death) has psychological consequences which may adversely effect sleep quality, this analysis shows that a major factor explaining the higher rate of sleep problems among the previously married is their more disadvantaged SES. Conclusions A large part of the well-known gender difference in reported sleep problems is mediated by the more disadvantaged socioeconomic status (SES) of women, casting doubt on the primacy of physiological explanations of this gender difference. In turn, SES is shown to impact on psychological distress and worries, which form part of the mechanism through which disadvantaged SES impacts on sleep problems. There are gender differences in the association of marital status with poor sleep with greater effects of marital status for men than women. Men who were previously married (whether divorced or widowers) have particularly poor sleep compared with their married counterparts. Whereas for women, these associations with marital status are less strong. However, among both men and women, a substantial proportion of the higher reported sleep problems of the divorced and widowed can be accounted for by their more disadvantaged SES. These findings that people with more disadvantaged SES report greater sleep problems need further consideration by health researchers. Despite sleep being important for health and well-being [3], previous research on gender inequalities in health has hitherto paid scant attention to gender differences in sleep problems or to how women's disadvantaged social position or gender roles mediate these differences. This research has shown strong linkages both between socio-economic variables and reported sleep problems, and between health variables and sleep problems. This suggests that low socio-economic status, family worries and women's family roles, may potentially be mechanisms that account for women's greater experience of sleep disruption. Acknowledgements The author acknowledges funding from the New Dynamics of Ageing initiative, a multidisciplinary research programme sup- 58 Przegl¹d Lekarski 2012 / 69 / 2 S. Arber
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Wzorzec-przegl d lekarski-XX-2001

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