Longitudinal associations between time-varying insomnia symptoms and all-cause healthcare services utilization among middle-aged and older adults in the US

Abstract This study examines longitudinal associations between time-varying insomnia symptoms (including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause healthcare services utilization (HSU; overnight hospital stays, nursing home stays, and home healthcare services) among middle-aged and older adults. Data were obtained from 2002 through 2018 waves of the Health and Retirement Study in the US for a population-representative sample of 13,168 adults (aged ≥50 years; mean [SD] age= 66.8±9.4; females= 57.7%; ≥2 comorbid medical conditions= 52.5%). A marginal structural modeling approach and generalized estimating equations were implemented to capture time-varying biological, psycho-cognitive, lifestyle, or behavioral health factors and to adjust for selection bias due to differential loss to follow-up. At baseline, 38.9% of respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 72.9%, 17.9%, and 35.1% reported overnight hospital stays, nursing home stays, and home healthcare services utilization, respectively. Higher numbers of insomnia symptoms on a cumulative scale were associated with more overnight hospital stays, nursing home stays, and home healthcare services utilization. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU compared to those not experiencing any of these symptoms. Independent associations of early-morning awakening with nursing home stays and home healthcare utilization were not significant. The results emphasize the roles of screening and addressing symptoms of insomnia among middle-aged and older adults or those prone to sleep disorders to reduce avoidable HSU. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.