Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study

Background:: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged 50 years. Methods:: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results:: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95 confidence interval (CI): 1.04 1.14), waking too early (OR = 1.05, 95 CI: 1.00 1.10), and, in adults aged 69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95 CI: 1.02 1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95 CI: 1.01 1.11) and feeling unrested (OR = 1.09, 95 CI: 1.04 1.15). Conclusions:: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population.