Economic and social determinants of health disparities in India: A systematic review of sleep literature

Among multiple determinants affecting sleep health, there is people socioeconomic status (SES), a multidimensional concept of an individuals social, economic and ecological position associated to public health inequalities at different levels. No systematic review on the relation between SES and sleep health has been previously conducted in India. Following Prisma protocol, seven articles were selected. Findings revealed that all studies were cross-sectional. The combined number of participants is N=12,746 participants, composed of 81.15% of adults (n=10,343), 10.56% of children (n=1346) and 8.29% of adolescents (n=1057). The smallest sample was N=268 and the larger was N=7017. The socioeconomic determinants the most reported by authors were perceived SES/composite indices, education, income and employment/occupation. The most reported sleep disturbances were obstructive sleep apnea (OSA), insomnia, restless legs syndrome (RLS) and sleep quality. Higher SES (specifically high education and high income) was associated on one hand in adults, with insomnia and a lower risk for OSA; and on the other hand, in adolescents, with poor quality of sleep and shorter sleep duration. Unemployment was significantly associated with insomnia and risk for pediatric OSA (specifically maternal employment). These findings are coherent with the conceptual socioeconomic model of sleep health published by Etindele Sosso et al. and one previous ecological model of sleep published by Grandner et al., both explaining the relationship between SES and sleep disparities. More studies on the subject and more longitudinal research are necessary to support public health programs related to sleep health disparities in India.