Abstract
IMPORTANCE: Understanding the outcomes of artificial light at night (ALAN) on insomnia is crucial for public health, particularly in rapidly urbanizing regions. However, evidence of the association between ALAN exposure and insomnia is limited, despite the large number of people exposed to ALAN. OBJECTIVE: To explore the association between outdoor ALAN exposure and insomnia among the Chinese population. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used social media data from Weibo (Sina), a social media platform, and satellite-derived nighttime light images. The study period spans from May 2022 to April 2023. The study encompasses 336 cities across China's mainland, providing a comprehensive national perspective. Data include insomnia-related posts from the platform users, representing a large and diverse population sample exposed to varying levels of ALAN. EXPOSURE: Outdoor ALAN exposure (in nanowatts per centimeters squared per steradian [nW/cm2/sr]) was measured using satellite-derived nighttime light images at a spatial resolution of 500 m. MAIN OUTCOMES AND MEASURES: The incidence of insomnia among residents at the city level was measured by the number of insomnia-related posts on social media. Multiple linear regression models were used to estimate the association between ALAN exposure and population insomnia, adjusting for population characteristics and meteorological factors at the city level. RESULTS: The study included data from 1 147 583 insomnia-related posts. Daily mean ALAN exposure across the 336 cities ranged from 3.1 to 221.0 nW/cm2/sr. For each 5 nW/cm2/sr increase in ALAN exposure, the incidence of insomnia increased by 0.377% (95% CI, 0.372%-0.382%). The association was greater in less populated cities and under extreme temperature and poor air quality conditions. The observed exposure-response functions between ALAN exposure and insomnia demonstrated an upward trend, with steeper slopes observed at low exposures and leveling off at higher exposures. CONCLUSIONS AND RELEVANCE: This study provides evidence of the association between increased ALAN exposure and higher incidence of insomnia. These findings expand the current knowledge on adverse health outcomes of ALAN exposure and emphasize the potential health benefits of well-planned artificial nighttime lighting in China and other developing countries in the early stages of city planning.