Categories of insuﬃcient rest/sleep <65 years of age 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend ≥65 years of age 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend Categories of insuﬃcient rest/sleep Normal weight (BMI <25 kg/m2) 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend Overweight/Obese (BMI >25 kg/m2) 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend 265278 70920 81902 32992 37806 10431 31227 111882 63676 24658 6759 6975 1721 8093 134529 49373 39532 14100 15100 4033 12391 242631 85223 67028 25651 29681 8119 26929 Journal of Environmental and Public Health 5 Table 4: Association between insuﬃcient rest/sleep and poor SRH, by age category. No. at risk No. with poor SRH Unadjusted odds ratio (95% conﬁdence intervals) Multivariable odds ratio (95% conﬁdence intervals)∗ ∗ Adjusted for sex (men, women), age (years), race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), education categories (<high school, high school, >high school), (employed, unemployed, retired, unable to work, homemaker, student), income category (quintiles), marital status, smoker (never, former, current), heavy drinker (no, yes), no regular exercise (yes, no), body mass index categories (<25, 25–29, ≥30 kg/m2), CVD (no, yes), depression (no, yes), and anxiety (no, yes). Table 5: Association between insuﬃcient rest/sleep and poor SRH, by BMI. No. at risk No. with poor SRH Unadjusted odds ratio (95% conﬁdence intervals) Multivariable odds ratio (95% conﬁdence intervals)∗ 40975 8961 7186 4416 7648 2460 10304 29803 14609 5004 2164 2932 764 4330 19836 7383 3346 1779 2697 822 3809 50942 16187 8844 4801 7883 2402 10825 ∗ Adjusted for sex (men, women), age (years), race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), education categories (<high school, high school, >high school), (employed, unemployed, retired, unable to work, homemaker, student), income category (quintiles), marital status, smoker (never, former, current), heavy drinker (no, yes), no regular exercise (yes, no), body mass index categories (<25, 25–29, ≥30 kg/m2), CVD (no, yes), depression (no, yes), and anxiety (no, yes). students, found an association between only short sleep duration and poor SRH [18]. A study by Jean-Louis et al. found no association between sleep duration and poor SRH, but this study used a sample of only 273 California residents [19]. The current study found a signiﬁcant association between insuﬃcient sleep and poor SRH using a sample size of 377,160, which is the largest study on this topic to date. Also, due to our large sample size, we were able to conduct detailed subgroup analyses by gender, age, race-ethnicity, and BMI and conﬁrm that the sleep-SRH association was present consistently within these subgroups. Studies have reported that poor SRH is an independent predictor of mortality [9, 14]. Studies have also shown that insuﬃcient sleep predicts mortality [19]. Based on our 1 (referent) 0.74 (.69–.79) 1.04 (.96–1.13) 1.64 (1.53–1.76) 1.92 (1.74–2.13) 3.04 (2.84–3.25) <0.0001 1 (referent) 0.90 (.84–.96) 1.61(1.46–1.78) 2.45 (2.23–2.69) 2.48 (2.07–2.98) 3.85 (3.54–4.19) <0.0001 1 (referent) 0.53 (.48–.58) 0.82 (.73–.92) 1.12 (1.01–1.25) 1.32 (1.13–1.55) 2.40 (2.18–2.66) <0.0001 1 (referent) 0.70 (.66–.75) 0.92 (.85–.99) 1.45 (1.35–1.54) 1.60 (1.44–1.77) 2.53 (2.38–2.68) <0.0001 1 (referent) 1.03 (.95–1.12) 1.42 (1.29–1.57) 2.09 (1.91–2.27) 2.34 (2.07–2.64) 2.66 (2.44–2.89) <0.0001 1 (referent) 1.06 (.98–1.14) 1.61 (1.44–1.80) 2.28 (2.07–2.52) 2.19 (1.79–2.69) 2.96 (2.68–3.26) <0.0001 1 (referent) 0.92 (.82–1.02) 1.52 (1.31–1.76) 2.03 (1.78–2.33) 2.27 (1.88–2.73) 2.85 (2.50–3.24) <0.0001 1 (referent) 1.09 (1.01–1.17) 1.43 (1.31–1.57) 2.15 (1.98–2.33) 2.35 (2.07–2.66) 2.66 (2.46–2.87) <0.0001