Data unavailable for years 2017 and 2019 for this measure.

Data Source

"The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based random digit dial (RDD) telephone survey that is conducted annually in all states, the District of Columbia, and U.S. territories. Data obtained from the BRFSS are representative of each state’s total non-institutionalized population over 18 years of age and have included more than 400,000 annual respondents with landline telephones or cellphones since 2011. Data are weighted using iterative proportional fitting (also called "raking") methods to reflect population distributions. For the County Health Rankings, data from the BRFSS are used to measure various health behaviors and health-related quality of life (HRQoL) indicators. HRQoL measures are age-adjusted to the 2000 U.S. standard population."

Measure Methods

• "Insufficient Sleep is a percentage: Insufficient Sleep is the percentage of adults who report sleeping less than 7 hours per night on average."

• "Insufficient Sleep estimates are age-adjusted: Age is a non-modifiable risk factor, and certain health behaviors may be associated with different age groups in the population. We report an age-adjusted rate to compare counties with differing age structures fairly."

• "The method for calculating Insufficient Sleep has changed: The CDC provides single-year modeled county-level estimates, including landline and cell phone users. Beginning with the 2021 Rankings, the CDC has updated its modeling procedure for producing small-area estimates. Also, in the 2021 Rankings, this measure is now age-adjusted. These changes were implemented to provide users with the most accurate estimates of health in their community as possible."

• "Insufficient Sleep estimates are created using statistical modeling: Statistical modeling is used to obtain more informed and reliable estimates than survey data alone can provide. Modeling generates more stable estimates for places with small numbers of residents or survey responses. The Insufficient Sleep estimates are produced from one year of survey data and are created using complex statistical modeling. Please see their methodology for more technical information on PLACES modeling using BRFSS data. There are also drawbacks to using modeled data. The smaller the population or sample size of a county, the more the estimates are derived from the model itself and the less they are based on survey responses. Models make assumptions about statistical relationships that may not hold in all cases. Finally, there is no perfect model, and each model generally has limitations specific to their methods."

• "Numerator: The numerator is the number of adults who responded to the following question by stating they sleep less than 7 hours per night: “On average, how many hours of sleep do you get in a 24-hour period?"

• "Denominator: The denominator is the county's total number of adult respondents."

• "Can This Measure Be Used to Track Progress?: This measure could be used to track progress only after considering its substantial limitations. In the 2021 Rankings, this measure was age-adjusted and underwent methodological changes, making comparisons with estimates from prior release years difficult. In addition, current estimates are produced using sophisticated modeling techniques, making them difficult to track progress, especially in small geographic areas. Modeled estimates have specific drawbacks about their usefulness in tracking progress in communities. Modeled data are not particularly good at incorporating the effects of local conditions, such as health promotion policies or unique population characteristics, into their estimates. Counties measuring the effects of programs and policies on the data should use great caution when using modeled estimates. To better understand and validate modeled estimates, confirming this data with additional data sources at the local level is particularly valuable."

Source: Insufficient Sleep* | County Health Rankings & Roadmaps

References

• Seixas AA, Gyamfi L, Newsome V, Ranger-Murdock G, Butler M, Rosenthal DM, Zizi F, Yousef I, McFarlane SI, Jean-Louis G. Moderating effects of sleep duration on diabetes risk among cancer survivors: analysis of the National Health Interview Survey in the USA. Cancer Management and Research. 2018; 10: 4575–4580.

• PLACES Project. Centers for Disease Control and Prevention. Accessed March 9, 2021. https://www.cdc.gov/places.