Introduction: Despite the substantial evidence of health benefits associated with adequate sleep duration, little is known about the relationship between sleep duration and healthcare expenditure. In this study, we examined the relationship between sleep duration and healthcare expenditure in an employee population.
Methods: Employees of Baptist Health South Florida voluntarily participated in a Health Risk Assessment in 2014 from which data for this study was obtained. Self-reported sleep duration for each participant was collected via a web-based questionnaire. In addition, participants were assessed for cardiovascular health (CVH) status using the American Heart Association’s ideal CVH construct and categorized as optimal and suboptimal CVH (5 - 7 metrics and 0 - 4 metrics at ideal levels respectively). Annual healthcare expenditure obtained from health insurance claims data was aggregated with participants’ data. Two-part regression models were used to calculate mean and marginal per-capita healthcare expenditures.
Results: Among all participants (n=9071), after adjusting for age, sex, educational attainment and ethnicity, the mean healthcare expenditure in persons who slept for between 6-7.9 and ≥8 hours was $6,167 and $6,117, compared to $8,098 in those that slept < 6 hours (see bar chart in figure). This corresponded to about $1932 (6-7.9h) and 1982 (≥8h) less in healthcare expenditure (vs. <6h). Adjusting further for obesity (BMI≥30kg/m2) or CVH (2 groups, see above) did not significantly alter these results (figure).
In sub-group analyses, persons who achieved optimal CVH (n=3574) had the greater costs benefits (> $3000) from ≥ 6 hours a day while those with suboptimal CVH profiles (n=5497) showed no statistically significant cost benefits associated with ≥6 hours of sleep (see bar charts in figure).
Conclusions: Workers who sleep ≥ 6 hours a day incur significantly lower healthcare costs compared to those who sleep < 6 hours a day independent of obesity or CVH status. The greatest reductions in healthcare expenditure were seen among persons with optimal CVH suggesting an effect modification by CVH on the association between sleep duration and healthcare costs. These findings highlight the need for promoting good sleep hygiene as well as heart healthy lifestyles among employee populations.