Social status differences in allostatic load among young adults in the United States

Abstract

Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994–1995) and IV (2007–2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents’ values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24–34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.

Education in the Jim Crow South and Black-White inequities in allostatic load among older adults

“…Although education – either measured as years of schooling or duration in school – attenuated Black-White inequities in allostatic load, only duration in school reduced race inequities in allostatic load to statistical non-significance in linear regression models. Studies focused on understanding Black-White inequities in allostatic load often adjust for educational attainment to account for confounding or to estimate mediation; however, educational attainment often explains little of the race inequity in allostatic load ( Mitchell et al, 2020 ; Moore et al, 2021 ; Richardson et al, 2021 ). This may be due to the use of an imprecise measure that ignores systemic structural racism in the education system ( Walsemann et al, 2013 ).…”

“…Our findings may also reflect the historically contingent and cohort dependent nature of education as an explanation for Black-White inequities in allostatic load. Several studies have found that, among Black men and/or women, education has a positive association with allostatic load, such that post-secondary schooling is related to higher allostatic load ( Howard & Sparks, 2015 ; Richardson et al, 2021 ; Sims & Coley, 2019 ). Yet, we found no evidence that the education—allostatic load relationship differed by race.…”

“…Indeed, only 7.5% of Black adults in our sample completed any post-secondary school compared to 22.2% of White adults in our sample. The samples utilized in studies that found effect modification ( Howard & Sparks, 2015 ; Richardson et al, 2021 ; Sims & Coley, 2019 ), however, were either mostly (or solely) comprised of adults who attended school after Brown when access to higher education was greater for Black adults. While more Black adults were able to attend college during the post- Brown era, doing so at predominantly White institutions also increases exposure to racial marginalization and discrimination ( Feagin et al, 1996 ; Lewis & Shah, 2021 ), which has been linked to poorer metabolic health ( Colen et al, 2021 ).…”

“…Racialized differences in allostatic load are increasingly documented ( Duru et al, 2012 ; Thomas et al, 2019 ). Because Black adults, on average, complete fewer years of school than their White counterparts, educational attainment is a common explanation for these racialized differences ( Howard & Sparks, 2015 ), even though it often does not explain them ( Mitchell et al, 2020 ; Moore et al, 2021 ; Richardson et al, 2021 ). Moreover, the educational gradient in allostatic load is not always similar in size or direction for White and Black adults.…”

Examining educational attainment and allostatic load in non-Hispanic Black women

“…This problem of single axis identity analysis underscores why intersectional research on Black women (the nexus of subordinated race and gender identities) is necessary. Correspondingly, an analysis of data from the National Longitudinal Study of Adolescent to Adult Health found that completion of higher education was no more or less protective for AL in Black women [ 14 ]. While methodological and technical limitations introduce difficulty in correlating perceived stress with adverse AL, there is an urgent need to explore the impact of social stressors on Black women in association with their educational achievement.…”