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Natali Sorajja





Brigham and Women's Hospital


Department of Sleep Medicine


Tamar Sofer, Natali Sorajja, Joon Chung, Susan Redline, Shakira Suglia, Carmen Isasi

Principal Investigator

Carmen Isasi, MD, PhD


An index measuring sociocultural gender-related exposures identifies non-biological effects on insomnia in the Hispanic Community Health Study/Study of Latinos

Despite gender’s significant interaction with sex and health, properly accounting for it in research is challenging when it is not explicitly measured. By creating a gendered index, we hope to facilitate inclusion of gender by encapsulating the gender-related patterns in sociocultural and psychological exposures, thus making gender’s effect on health issues easier to gauge and interpret. Our quantitative measure does not attempt to eradicate the biological components of gender, but seeks to include them due to their heavy interaction with the societal aspects. In the future, we hope our gendered index can be used and generalized to other studies examining various health issues, thus allowing for inclusion of both biological sex and sociocultural gendered effects.


Gender encompasses both biological sex and its accompanying gender norms implicated by society, and it is a significant social determinant of health. Properly accounting for gender in research can aid in design of public health interventions. Insomnia is more prevalent in women compared to men, with evidence for gender bias related to both biological factors such as sex hormones, and sociocultural factors such as employment patterns. For example, in the Hispanic Community Health Study/Study of Latinos (HCSH/SOL) 35% of women and 24% of men have self-reported insomnia. However, distinguishing the biological from sociocultural gender effects on insomnia in HCHS/SOL remains difficult due to a lack of a quantitative measure that encapsulates the different aspects of gender. We have created a sociocultural gendered index that can be used as a proxy to measure gender. Using various gender-biased sociocultural variables such as employment status, income, and social acculturation, we used coefficients from penalized regression (LASSO) to calculate a gendered index, adjusting for baseline variables including age, background, and study center. We created two indices: one index purely consisting of sociocultural variables and one index with both sociocultural variables and psychological factors (anxiety and depression). Men tended to have higher values of the indices while women tended to have lower values. The two indices were used to estimate sociocultural gendered burden on insomnia. Higher scores of traditionally masculine sociocultural patterns were significantly associated with lower odds of insomnia, as indicated by significant associations of the indices with insomnia: one standard deviation (SD) increase in the primary index had an odds ratio (OR) of 0.87 for insomnia and one SD increase in the secondary index had an OR of 0.53. Sex-stratified analysis indicated that in both men and women higher index values associated with traditionally masculine sociocultural patterns were associated with lower insomnia risk.

Research Context