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Importance: The association between long sleep duration and mortality appears stronger in East Asian populations than in North American or European populations. Objectives: To assess the sex-specific association between sleep duration and all-cause and major-cause mortality in a pooled longitudinal cohort and to stratify the association by age and body mass index. Design, Setting, and Participants: This cohort study of individual-level data from 9 cohorts in the Asia Cohort Consortium was performed from January 1, 1984, to December 31, 2002. The final population included participants from Japan, China, Singapore, and Korea. Mean (SD) follow-up time was 14.0 (5.0) years for men and 13.4 (5.3) years for women. Data analysis was performed from August 1, 2018, to May 31, 2021. Exposures: Self-reported sleep duration, with 7 hours as the reference category. Main Outcomes and Measures: Mortality, including deaths from all causes, cardiovascular disease, cancer, and other causes. Sex-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression with shared frailty models adjusted for age and the key self-reported covariates of marital status, body mass index, smoking status, alcohol consumption, physical activity, history of diabetes and hypertension, and menopausal status (for women). Results: For 322721 participants (mean [SD] age, 54.5 [9.2] years; 178542 [55.3%] female), 19419 deaths occurred among men (mean [SD] age of men, 53.6 [9.0] years) and 13768 deaths among women (mean [SD] age of women, 55.3 [9.2] years). A sleep duration of 7 hours was the nadir for associations with all-cause, cardiovascular disease, and other-cause mortality in both men and women, whereas 8 hours was the mode sleep duration among men and the second most common sleep duration among women. The association between sleep duration and all-cause mortality was J-shaped for both men and women. The greatest association for all-cause mortality was with sleep durations of 10 hours or longer for both men (hazard ratio [HR], 1.34; 95% CI, 1.26-1.44) and women (HR, 1.48; 95% CI, 1.36-1.61). Sex was a significant modifier of the association between sleep duration and mortality from cardiovascular disease (χ25= 13.47, P =.02), cancer (χ25= 16.04, P =.007), and other causes (χ25= 12.79, P =.03). Age was a significant modifier of the associations among men only (all-cause mortality: χ25= 41.49, P <.001; cancer: χ25= 27.94, P <.001; other-cause mortality: χ25= 24.51, P <.001). Conclusions and Relevance: The findings of this cohort study suggest that sleep duration is a behavioral risk factor for mortality in both men and women. Age was a modifier of the association between sleep duration in men but not in women. Sleep duration recommendations in these populations may need to be considered in the context of sex and age.
|Journal||JAMA Network Open|
|Publication status||Published - 2021|
Bibliographical noteFunding Information:
Conflict of Interest Disclosures: Dr Mimura reported receiving personal fees from Byer Pharmaceutical, Daiichi Sankyo, Dainippon-Sumitomo Pharma, Eisai, Eli Lilly, Fuji Film RI Pharma, Hisamitsu Pharmaceutical, Janssen Pharmaceutical, Kyowa Pharmaceutical, Mochida Pharmaceutical, MSD, Mylan EPD, Nihon Medi-physics, Nippon Chemipher, Novartis Pharma, Ono Yakuhin, Otsuka Pharmaceutical, Pfizer, Santen Pharmaceutical, Shire Japan, Takeda Yakuhin, Tsumura, and Yoshitomi Yakuhin and grants from Daiichi Sankyo, Eisai, Pfizer, Shionogi, Takeda, Tanabe Mitsubishi, and Tsumura outside the submitted work. Dr Sawada reported receiving grants from National Cancer Center Research and Development Fund during the conduct of the study. No other disclosures were reported.
Funding/Support: The cohorts participating in the pooled analysis were supported by the following grants: grants 23-A-31 (Toku), 26-A-2, 29-A-4, and 2020-J-4 (since 2011), Japan Public Health Center–based prospective studies 1 and 2, National Cancer Center Research and Development Fund; a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour, and Welfare of Japan (1989-2010); grants R37 CA070867 and UM1 CA182910 from the Shanghai Women’s Health Study, US National Cancer Institute; grants R01CA144034 and U01CA182876 from the Singapore Chinese Health Study, National Institutes for Health; grants R01 CA082729 and UM1 CA173640 from the Shanghai Men’s Health Study, the US National Cancer Institute; grant H21-3jigan-ippan-003 from the Ohsaki National Health Insurance Cohort Study, Grants-in-Aid for Cancer Research and for the Third Term Comprehensive Ten-Year Strategy for Cancer Control, Ministry of Health, Labour and Welfare; grant H21-3jigan-ippan-003 from the Miyagi Cohort, Grants-in-Aid for Cancer Research and for the Third Term Comprehensive Ten-Year Strategy for Cancer Control, Ministry of Health, Labour and Welfare; grant 2009-0087452 from the Takayama Study, National Cancer Center Research and Development Fund; and Korea Multicenter Cancer Cohort Study, Ministry of Education, Science and Technology, South Korea; and grant 2009-0087452 from the National Research Foundation of Korea.
© 2021 American Medical Association. All rights reserved.
Copyright 2021 Elsevier B.V., All rights reserved.
Subject classification (UKÄ)
- Public Health, Global Health, Social Medicine and Epidemiology
- Cardiac and Cardiovascular Systems
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