Abstract
The importance of sleep for physical and mental health is well recognized. Despite its importance, sleep quality and quantity vary by race and gender, and previous studies suggest that racial and ethnic minorities experience poorer sleep outcomes than White populations. This study examined disparities in clinically diagnosed sleep disorders using Electronic Health Records (EHRs) from a large urban public hospital. The analysis focused on how race, gender, and their intersection influenced the diagnosis of sleep apnea and insomnia. Stratified logistic regression models showed that, after adjusting for demographic and clinical factors, White individuals had higher odds of receiving a sleep apnea diagnosis than Black individuals, while women had lower odds than men. In contrast, White individuals had lower odds of receiving an insomnia diagnosis than Black individuals, and women had higher odds than men. The study also examined whether Black women had higher odds of receiving sleep disorder diagnoses because of the cumulative effects of social and structural stressors. The findings supported this hypothesis for sleep apnea. Black women had higher odds of receiving a sleep apnea diagnosis than non-Black women, even after adjusting for obesity and other comorbid conditions. However, no significant difference was found between Black and non-Black women in the diagnosis of insomnia. Although obesity remains a well-established risk factor for sleep apnea, these findings suggest that structural and systemic disadvantages, beyond biological factors alone, also contribute to racial and gender disparities in clinically diagnosed sleep disorders.