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The Economic Costs of Insufficient Sleep

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The Economic Costs of Insufficient Sleep Why sleep matters – the economic costs of insufficient sleep A cross-country comparative analysis Marco Hafner, Martin Stepanek, Jirka Taylor, Wendy M. Troxel, Christian van Stolk For more information on this publication, visit www.rand.org/t/RR1791 Published by the RAND Corporation, Santa Monica, Calif., and Cambridge, UK © Copyright 2016 RAND Corporation R® is a registered trademark. RAND Europe is a not-for-profit organisation whose mission is to help improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org www.rand.org/randeurope Preface This report presents the findings of a study on the causes, consequences and related economic costs of insufficient sleep. The report will be of interest to employers, policy-makers, and the wider society and people interested in the field of sleep, health and wellbeing and health economics in general. RAND Europe is an independent not-for-profit policy research organisation that aims to improve policy and decision-making in the public interest through research and analysis. This report has been peer reviewed in accordance with RAND’s quality assurance standards. For more information about RAND Europe or this document, please contact Marco Hafner ([email protected]): RAND Europe Westbrook Centre, Milton Road Cambridge CB4 1YG United Kingdom Tel. +44 1223 353 329 i Abstract This report examines the economic burden of insufficient sleep across five different OECD countries. Taking into account the association between sleep deprivation and mortality, as well as productivity, the findings of this study suggest that insufficient sleep can result in large economic costs in terms of lost GDP. ii Table of Contents Preface ....................................................................................................................................................... i Abstract ..................................................................................................................................................... ii Figures ...................................................................................................................................................... v Tables ...................................................................................................................................................... vi Executive summary ................................................................................................................................. vii Acknowledgements ..................................................................................................................................xv Abbreviations ......................................................................................................................................... xvi 1. Introduction ....................................................................................................................................... 1 1.1. Insufficient sleep as a public health problem ................................................................................... 1 1.2. Causes of insufficient sleep .............................................................................................................. 4 1.3. Objectives of the study .................................................................................................................... 5 1.4. Research approach .......................................................................................................................... 7 1.5. Structure of this report .................................................................................................................... 8 2. Factors associated with insufficient sleep duration ............................................................................... 9 2.1. Factors associated with sleep duration - a glance at the literature ..................................................... 9 2.2. Using large-scale employer-employee data to analyse the factors associated with insufficient sleep duration ............................................................................................................................... 10 2.3. Measuring and modelling the factors associated with sleep duration .............................................. 11 2.4. Descriptive characteristics of the study sample .............................................................................. 13 2.5. Empirical findings from the regression analysis ............................................................................. 17 2.5.1. Lifestyle and health factors ................................................................................................. 19 2.5.2. Personal and socio-demographic factors ............................................................................. 21 2.5.3. Psychosocial and job factors ............................................................................................... 22 2.5.4. Magnitude of the estimated sleep duration effects .............................................................. 24 3. Insufficient sleep and mortality ......................................................................................................... 26 iii 3.1. Insufficient sleep and mortality – existing empirical evidence ........................................................ 26 3.2. What is Meta-(regression) analysis? ............................................................................................... 28 3.3. MRA for the relationship between short sleep and all-cause mortality ........................................... 29 3.3.1. The meta-sample: systematic review and data collection .................................................... 29 3.3.2. Meta-regression analysis and publication selection bias ...................................................... 30 3.3.3. Taking into account study heterogeneity ........................................................................... 33 3.3.4. Short sleep duration and all-cause mortality risks for sub-categories ................................... 36 4. Quantifying the economic effects of insufficient sleep ....................................................................... 38 4.1. Insufficient sleep and workplace productivity ................................................................................ 38 4.1.1. Measuring workplace productivity loss .............................................................................. 39 4.1.2. Sleep and workplace productivity – empirical findings ....................................................... 40 4.1.3. Working time lost due to insufficient sleep – a cross-country perspective ........................... 42 4.2. The macroeconomic effects of insufficient sleep ............................................................................ 43 4.2.1. Conceptual approach and scope of the analysis .................................................................. 43 4.2.2. A dynamic general equilibrium model to assess the economic costs of insufficient sleep .......................................................................................................................................... 44 4.2.3. Key parameters to calibrate the model ............................................................................... 47 4.2.4. Simulation results .............................................................................................................. 50 5. Discussion and recommendations ..................................................................................................... 53 5.1. Discussion .................................................................................................................................... 54 5.2. Recommendations ........................................................................................................................ 54 5.2.1. Recommendations targeting individuals ............................................................................ 55 5.2.2. Recommendations targeting employers .............................................................................. 56 5.2.3. Recommendations targeting public authorities .................................................................. 58 References ............................................................................................................................................... 61 Appendix A: List of studies used in the meta-analysis .............................................................................. 76 Appendix B: Macroeconomic model description ..................................................................................... 77 iv Figures Figure 3.1: Funnel plot of relative mortality risks related
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