Sleep insufficiency and life expectancy at the state-county level in the United States, 2019-2025

STUDY OBJECTIVES: Millions of Americans obtain insufficient sleep daily, yet it is unknown the relationship between sleep and life expectancy by county across the United States. METHODS: Using the 2019-2025 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System surveys, we tested the associations between insufficient sleep and life expectancy at the county level while controlling for common adverse health behaviors (i.e. smoking, diet, and inactivity) across multiple years (2019-2025). RESULTS: Insufficient sleep was significantly negatively correlated with life expectancy in most states from 2019 to 2025, such that lower sleep insufficiency was associated with longer life expectancy. Moreover, sleep insufficiency was significantly associated with lower life expectancy when controlling for traditional predictors of mortality, with only smoking displaying a stronger association. CONCLUSIONS: These findings demonstrate the importance of adequate sleep in all communities regardless of income level, access to health care services, or geographical classification.