Insomnia and cumulative unhealthy behaviors among older adults: implications for sustainable health promotion
1
Departamento de Medicina Preventiva; Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
2
Departamento de Política, Gestão e Saúde da Faculdade de Saúde Pública, Universidade de Sao Paulo, Sao Paulo, Brazil
3
Departamento de Epidemiologia da Faculdade de Saúde Pública, Universidade de Sao Paulo, Sao Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A97
ABSTRACT
BACKGROUND:
Sleep quality is associated with physical and mental health, influencing well-being and the risk of chronic diseases. Unhealthy lifestyle behaviors have been individually associated with sleep outcomes; however, evidence on their cumulative effects among older adults remains limited. This study aimed to estimate the prevalence of insomnia and examine its association with the accumulation of unhealthy behaviors among older adults living in São Paulo, Brazil.
METHODS:
This population-based cross-sectional study used data from the ISA-Capital 2024 survey, including older adults aged 60 years or older (n = 1,482), representative of the elderly population residing in the city of São Paulo. Self-reported information on insomnia, multimorbidity, sedentary behavior, physical exercise, alcohol consumption, and smoking was analyzed. A cumulative exposure score ranging from 0 to 5 was constructed to reflect the coexistence of unhealthy behaviors and chronic conditions. Prevalence estimates and Prevalence Ratios (PR) were adjusted for sociodemographic characteristics and were calculated using Poisson regression models.
RESULTS:
Overall, 32.9% of participants reported insomnia. In adjusted analyses, a higher probability of insomnia was observed among individuals with multimorbidity (PR=1.65; 95 %Confidence Intervals 1.29–2.11) and among those reporting alcohol consumption (PR=1.26; 95%CI 1.02–1.56), compared with their respective reference groups. In addition, the simultaneous presence of two, three, four or five unhealthy behaviors and chronic conditions was associated with increased probabilities of insomnia, corresponding to increases of 51% (PR=1.51; 95%CI 1.12–2.03), 37% (PR=1.37; 95%CI 1.02–1.83), 72% (PR=1.72; 95%CI 1.26–2.37) and 85% (PR=1.85; 95%CI 1.22–2.79), respectively, compared with individuals presenting up to one unhealthy behavior or chronic condition.
CONCLUSIONS:
These findings highlight the need for integrated public health policies that move beyond single-risk approaches and promote coordinated, system-level, multi-behavior interventions, particularly among older adults exposed to cumulative health risks.
Sleep quality is associated with physical and mental health, influencing well-being and the risk of chronic diseases. Unhealthy lifestyle behaviors have been individually associated with sleep outcomes; however, evidence on their cumulative effects among older adults remains limited. This study aimed to estimate the prevalence of insomnia and examine its association with the accumulation of unhealthy behaviors among older adults living in São Paulo, Brazil.
METHODS:
This population-based cross-sectional study used data from the ISA-Capital 2024 survey, including older adults aged 60 years or older (n = 1,482), representative of the elderly population residing in the city of São Paulo. Self-reported information on insomnia, multimorbidity, sedentary behavior, physical exercise, alcohol consumption, and smoking was analyzed. A cumulative exposure score ranging from 0 to 5 was constructed to reflect the coexistence of unhealthy behaviors and chronic conditions. Prevalence estimates and Prevalence Ratios (PR) were adjusted for sociodemographic characteristics and were calculated using Poisson regression models.
RESULTS:
Overall, 32.9% of participants reported insomnia. In adjusted analyses, a higher probability of insomnia was observed among individuals with multimorbidity (PR=1.65; 95 %Confidence Intervals 1.29–2.11) and among those reporting alcohol consumption (PR=1.26; 95%CI 1.02–1.56), compared with their respective reference groups. In addition, the simultaneous presence of two, three, four or five unhealthy behaviors and chronic conditions was associated with increased probabilities of insomnia, corresponding to increases of 51% (PR=1.51; 95%CI 1.12–2.03), 37% (PR=1.37; 95%CI 1.02–1.83), 72% (PR=1.72; 95%CI 1.26–2.37) and 85% (PR=1.85; 95%CI 1.22–2.79), respectively, compared with individuals presenting up to one unhealthy behavior or chronic condition.
CONCLUSIONS:
These findings highlight the need for integrated public health policies that move beyond single-risk approaches and promote coordinated, system-level, multi-behavior interventions, particularly among older adults exposed to cumulative health risks.
| eISSN: | 2654-1459 |
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