Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life

Abstract

Objectives Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk. Methods We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000–2016). The sample includes 13,589 respondents (10,607 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline. Results Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults. Discussion The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.

Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults

“…Third, additional family member deaths after age 50 did not add to cardiometabolic conditions in the present study when accounting for sociodemographic covariates and earlier life exposure to bereavement. This finding does not align with prior research on the consequences of exposure to the death of a sibling or spouse in later life for dementia (Cha et al 2021) and mortality (Liu et al 2020) among older adults. However, some of the prior research on later-life bereavement does not consider exposure to additional family member deaths earlier in life (e.g., Liu et al 2020), which may provide an incomplete picture of the health consequences of bereavement.…”

“…This finding does not align with prior research on the consequences of exposure to the death of a sibling or spouse in later life for dementia Note: HRS = Health and Retirement Study; NH = non-Hispanic. (Cha et al 2021) and mortality (Liu et al 2020) among older adults. However, some of the prior research on later-life bereavement does not consider exposure to additional family member deaths earlier in life (e.g., Liu et al 2020), which may provide an incomplete picture of the health consequences of bereavement.…”

“…Second, we underscore the racial context of bereavement in the United States, wherein Black adults experience an unequal burden of family deaths (Umberson et al 2017) and inequities in cardiometabolic health (Bibbins-Domingo et al 2009; Mitchell et al 2019; Williams et al 2010). Whereas recent research documents that unequal exposure to bereavement contributes to racial disadvantage in psychological distress (Umberson and Donnelly 2021), dementia (Cha, Thomas, and Umberson 2021; Liu, Lin, and Umberson 2022; Umberson et al 2020), and mortality risk (Donnelly et al 2020; Liu, Umberson, and Xu 2020), we extend prior research by examining the health consequences of racial inequities in exposure to multiple family member deaths across the life course. Therefore, the present study emphasizes that differential exposure to repeated bereavement events across the life course may contribute to racial inequities in cardiometabolic health for aging adults.…”

“…Compared to white adults, Black adults are also more likely to experience the death of a parent, to be widowed, and to experience a sibling death (Umberson et al 2017). Recent research shows that these disparities contribute to the higher rates of dementia (Cha et al 2021; Liu et al 2022) and mortality (Liu et al 2020) among aging Black adults.…”

“…Although the present study is primarily focused on the lasting consequences of bereavement prior to midlife, exposure to additional deaths in mid and later life are likely to take a further toll on health. For example, prior research documents the heightened risk of adverse health outcomes and mortality following the death of a sibling (Cha et al 2021) or spouse (e.g., Liu et al 2020; Shor et al 2012) in later life. We suggest that experiencing the death of family members after midlife adds to a lifetime burden of bereavement, with adverse consequences for the health of aging adults.…”