Explaining social inequalities in health by sleep: the Japanese civil servants study
Abstract
BACKGROUND: Individuals of low socioeconomic status (SES) are likely to have poor sleep and poor health. This study aims to evaluate whether and how much of the socioeconomic differences in health are explained by sleep. METHODS: The subjects were 3684 (2471 males and 1213 females) employees aged 20-65 working in local government in Japan. A questionnaire survey was conducted in January 2003. Analysis of covariance (ANCOVA) was performed to examine the association of employment-grade with sleep, measured by the Pittsburgh Sleep Quality Index (PSQI), and with health, measured by the Physical and Mental Component Summary Scales (PCS and MCS) of the Short Form-36 (SF-36). RESULTS: In men, higher grade employees had better sleep and better health. The age-adjusted difference between the highest and the lowest grade employees was 1.9 points (95% confidence interval = 1.0-3.0) in the PCS and 3.4 points (1.8-4.9) in the MCS. The grade difference in health reduced to 1.5 points (0.5-2.5) in the PCS (21.1% reduction) and 2.0 points (0.6-3.4) in the MCS (41.2% reduction), when the PSQI global score was adjusted for. The grade differences in sleep quality contributed more to the health inequalities than sleep quantity. Among women, no significant grade differences were observed in the PSQI global score. The grade differences in the PCS and MCS were weaker and less consistent than those of men, and the differences hardly changed when the PSQI global score was adjusted for. CONCLUSION: Sleep quality may mediate the relationship between SES and physical and, in particular, mental health in men.
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Self-reported sleep duration is widely used in epidemiologic studies and is the basis of research on the relation between sleep duration and mortality.
“Self-reported sleep duration is widely used in epidemiologic studies and is the basis of research on the relation between sleep duration and mortality (13)(14)(15)(16)(17)(18)(19).”
From Sleep Duration in the United States: A Cross-sectional Population-based Study (2009) · cites this paper as [15]
Sleep durations longer or shorter than 7-8 hours in a 24-hour period are associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, learning and memory problems, and excess mortality.
“Sleep duration is associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, and prospective mortality.”
From Sleep Duration in the United States: A Cross-sectional Population-based Study (2009) · cites this paper as [15]
Many covariates have established relations with the risk of death and might account for the relation between sleep duration and mortality.
“Many of our covariates have established relations with the risk of death (25,65) and might account for the relation between sleep duration and mortality (13)(14)(15)(16)(17)(18).”
From Sleep Duration in the United States: A Cross-sectional Population-based Study (2009) · cites this paper as [15]
Self-reported sleep duration reliably predicts prospective mortality and other health outcomes.
“self-reported sleep duration reliably predicts prospective mortality and other health outcomes (1-7, 13-18).”
From Sleep Duration in the United States: A Cross-sectional Population-based Study (2009) · cites this paper as [15]
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Khalili, Z., Sadrollahi, A., Aseman-Bashiz, E., Gholipour, F., & Abbasian, M. (2016) · فصلنامه پرستاری سالمندان · doi:10.21859/jgn.2.3.32 · Cited by 2 · see citing works
Evaluation factors associated with sleep quality in the elderly shahid Beheshti hospital of Kashan
Khalili, Z., Sadrollahi, A., Aseman-Bashiz, E., & Gholipour, F. (2017) · Cited by 2 · see citing works
Nose, S., Sekine, M., Tatsuse, T., & Yamada, M. (2022) · Journal of Occupational Health · doi:10.1002/1348-9585.12363 · Cited by 2 · see citing works
Self-citationSleep as a Bio-behavioral Risk Factor for Cardiovascular Disease
Hall, M. H., Greeson, J. M., & Pantesco, E. J. (2022) · Springer eBooks · doi:10.1007/978-0-387-85960-6_17 · Cited by 2 · see citing works
Oishi, K., Aoki, T., Yamatsu, K., Watanabe, M., Komura, K., Tsuji, N., Tanaka, C., Abe, T., Kasanami, R., Kume, D., et al. (2022) · Japan Journal of Human Growth and Development Research · doi:10.5332/hatsuhatsu.2022.94_17 · Cited by 1 · see citing works
Yepez, C. E., Anderson, C. E., Frost, E., Whaley, S. E., & Koleilat, M. (2023) · American Journal of Health Promotion · doi:10.1177/08901171231225289 · Cited by 1 · see citing works
Alcohol Drinking Patterns and Sleep Quality of Male Workers in Manufacturing Industries
Choi, S.-K., Park, S.-K., & Cho, Y.-C. (2018) · Journal of the Korea Academia-Industrial cooperation Society · doi:10.5762/kais.2018.19.11.105
Social and economic impact (65)
Åkerstedt, T. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00248-6
Grubic, N., Maximova, K., Chioléro, A., Siddiqi, A., Carsley, S., Batomen, B., Harris, K. M., & Carmeli, C. (2025) · CJC Open · doi:10.1016/j.cjco.2025.08.002 · Cited by 1 · see citing works
Prefrontal markers of spatial attention
Ferreira, C. D. S. (2021) · doi:10.70675/fb26d059zc23dz413eza6f4z830427c1478c
Tanaka, K., Ikeda, A., Sato, S., Suzuki, Y., Maruyama, K., Charvat, H., Tomooka, K., Wada, H., Koyama, Y., & Tanigawa, T. (2026) · Sleep And Breathing · doi:10.1007/s11325-026-03830-9
- Authors
- Sekine, M., Chandola, T., Martikainen, P., McGeoghegan, D., Marmot, M., & Kagamimori, S.
- Affiliations
- University of Toyama (JP)
- Venue
- Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-03-01
- Volume
- 28
- Issue
- 1
- Pages
- 63-70
- ISSN
- 0943-1853 (ISSN-L)
- 1741-3842
- 1741-3850
- OpenAlex
- W2168491742
- Cited by
- 71
- References
- 38
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 2 · 2014: 4 · 2013: 4 · 2012: 9
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (HS06516)
- National Institute on Aging (AG 13196)
- National Heart, Lung, and Blood Institute (HL36310, R01HL036310)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep quality, socioeconomic inequalities in health, health disparities, sleep quantity, employment grade, public sector employees, sex differences
- MeSH terms
- Adult, Aged, Data Interpretation, Statistical, Female, Government Agencies, Health Status Indicators, Humans, Japan, Male, Mental Health, Middle Aged, Surveys and Questionnaires, Sleep, Sleep Wake Disorders, Social Class, Socioeconomic Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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