Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation

Abstract

Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors—collectively and individually—mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status–health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate—by between 5% and 30%—the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.

Patterns and Life Course Determinants of Black–White Disparities in Biological Age Acceleration: A Decomposition Analysis

“…Third, we assess the role of racial differences in vulnerability to socioeconomic and stress exposures in shaping racial disparities in biological aging. Evidence supporting the “diminishing returns hypothesis” indicates that Black individuals experience fewer health protections from increases in SES than Whites ( Assari 2018 ; Boen 2016 ; Brown et al 2023 ; Colen et al 2018 ; Gaydosh et al 2018 ; Graetz et al 2022 ; Hargrove et al 2022 ). Racial discrimination and exposure to high levels of contextual deprivation are some of the factors thought to restrict higher SES Black individuals, in particular, from converting socioeconomic gains into health improvements in the same ways as White individuals ( Colen et al 2018 ; Hargrove et al 2022 ).…”

“…Hence, studies on racial disparities in biological aging should integrate multiple life course measures of socioeconomic and psychosocial stress exposures to more comprehensively capture the role of social and environmental factors in patterning race gaps in aging ( Raffington and Belsky 2022 ). Further, a mounting body of evidence documents heterogeneity of the impacts of social exposures on health risks by race, with Black and White individuals having differential vulnerability to social exposures, including socioeconomic and stress exposures ( Assari 2018 ; Boen 2016 ; Boen et al 2020 ; Brown, Mitchell, and Ailshire 2020 ; Brown et al 2023 ; Colen et al 2018 ; Ferraro and Morton 2020 ; Gaydosh et al 2018 ; Hargrove et al 2022 ). Still, few studies of racial disparities in biological aging have assessed whether socioeconomic or stress gradients operate differently by race, accentuating the need for better understanding the role of these life course social exposures in generating racial disparities in biological aging.…”

“…The social factors contributing to racial inequities in morbidity and mortality are complex and multifaceted, but studies point to two interrelated pathways linking racism to racialized morbidity and mortality risks ( Brown et al 2023 ). First, racism patterns Black–White health and mortality gaps through the unequal distribution of socioeconomic risks, resources, and opportunities across the life span ( Boen 2016 ; Graetz et al 2022 ; Hayward et al 2000 ; Phelan and Link 2015 ).…”

Racial/ethnic differences in living arrangements, distant relations, and later‐life mental health

“…This paper posits that these questions must be answered through the lens of critical race theory. Critical race theory is an intellectual framework that critically examines the ways in which racism is deeply ingrained in social, economic, political, and legal domains (Allen & Henderson, 2022;Brown et al, 2023;Delgado & Stefancic, 2023;Dow et al, 2022). Applied to this study, it highlights that systemic racial disparities in the distribution of stressors and resources shape racial/ethnic differences in resource pooling needs (Courtin & Avendano, 2016;Isengard & Szydlik, 2012;Keene & Batson, 2010) and cultural norms (Russell & Taylor, 2009;Ward & Spitze, 1992), leading to distinct characteristics in both household patterning (Crimmins & Ingegneri, 1990;Kamo, 2000;Swartz, 2009;Van Hook & Glick, 2007) and quantity and quality of social networks (Ajrouch et al, 2001;Cornwell et al, 2008;Taylor et al, 2013).…”

Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study

“… 12 , 13 , 14 , 15 , 16 , 17 Frequently, the term “race” is used to ascribe individuals to groups based on ancestral origin, which is assumed to contribute to genetic, cultural, educational, and socioeconomic characteristics of group members. Instead, we use the term “racialization” 18 , 19 , 20 , 21 , 22 , 23 , 24 to emphasize the complex historical, social, and political processes that form the racialized categories. This term also indicates that the processes forming and reinforcing those categories are, frequently and to a large extent, driven and informed by values, judgments, biases, and sociopolitical structures external to the affected individuals and groups.…”