Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos

Social Determinants of Health and Biological Age among Diverse U.S. Adults, NHANES 2011-2018

We examined the sex-specific association between education and income with biological age (BA) and by race/ethnicity. The Klemera-Doubal method was used to calculate BA among 6,213 females and 5,938 males aged 30-75 years who were Hispanic, non-Hispanic (NH) White, NH Black (NHB), or NH Asian (NHA). Compared with a college education, less than a high school education was associated with greater BA by 3.06 years (95% CI: 1.58, 4.54) among females only; associations were strongest among NHB, Hispanic, and NHA females. Compared with an annual income of ≥$75,000, an income <$25,000 was associated with greater BA by 4.95 years (95% CI: 3.42, 6.48) among males and 2.76 years among females (95% CI: 1.51, 4.01); associations were strongest among NHW and NHA adults, and Hispanic males. Targeting upstream sources of structural disadvantage among racial/ethnic minority groups, in conjunction with improvements in income and education, may promote healthy aging in these populations.

Participation in Pediatric Primary Care Innovation, DULCE, Increases Caregiver Agency and Resilience and Decreases Impact of Stress

The purpose of the present study was to explore outcomes and heterogeneous effects of an evidence-based, cross-sector pediatric healthcare intervention for families with infants, Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is tailored to allow families' needs and desires to drive DULCE intensity. This is a longitudinal study following families involved with pediatric primary care clinics from infant's birth to 15 months. Multi-level longitudinal modeling was used to compare the program's influence on resilience, parent agency, and the impact of stress on parent functioning among program recipients (n = 172) and non-recipients (n = 170). Study participants were recruited from four health care clinics in California and Florida, and participants completed in-person survey interviews at baseline (infant age 0-6 months) and final (infant age 12-15 months) timepoints, with a minimum of 6 months between baseline and final interview required. Assignment of families to intervention (participated in DULCE) or comparison group (received clinic care as usual) varied by clinic. The cross-sector pediatric primary care intervention screened families at high rates (70-90%), along with referring and connecting families to resources. DULCE participation was associated with increases in parents' agency and resilience. DULCE's positive influence on parent agency and impact of stress was observed with low dosage, and higher-risk families saw additional improvements in resilience at high dosage (high and low risk defined with Latent Profile Analysis). Findings reinforce the importance of examining heterogeneous effects of evidence-based interventions. DULCE's influence on parent agency and impact of stress was observed with low dosage; strengthened resilience among higher-risk families was found at high dosage. These findings document the value of a universal approach to prevention services in pediatric settings with tailoring that allows families to drive their engagement with the intervention.

Associations of Allostatic Load with Level of and Change in Cognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: The Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA)

Background

Higher allostatic load (AL), a multi-system measure of physiological dysregulation considered a proxy for chronic stress exposure, is associated with poorer global cognition (GC) in older non-Hispanic white adults. However, evidence of these associations in middle-aged and older US-based Hispanic/Latino adults is limited.

Objective

To examine associations of AL with level of cognition, performance in cognition 7 years later, and change in cognition over 7 years among middle-aged and older US-based Hispanic/Latino adults.

Methods

We used data (n = 5,799, 45-74 years at baseline) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation of Neurocognitive Aging (SOL-INCA). The AL score comprised 16 biomarkers representing cardiometabolic, glucose, cardiopulmonary, parasympathetic, and inflammatory systems (higher scores = greater dysregulation). Cognitive outcomes included GC and individual tests of verbal learning and memory, world fluency (WF), Digit Symbol Substitution (DSS), and Trail Making (Parts A & B). Survey-linear regressions assessed associations of AL with performance in cognition at baseline, 7 years later, and via 7-year cognitive change scores adjusting for sociodemographic characteristics, lifestyle factors, and depressive symptoms.

Results

Higher AL was associated with lower baseline performance in GC and WF; and lower 7-year follow-up performance in these same measures plus DSS and Trail Making Parts A & B. Higher AL was associated with more pronounced 7-year change (reduction) in GC and on WF and DSS tests.

Conclusions

Findings extend previous evidence in predominantly older non-Hispanic white cohorts to show that AL is related to level of and change in GC (as well as WF and DSS) among middle-aged and older US-based Hispanic/Latino adults.

Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts

BACKGROUND

Increasing numbers of opioid-overdose deaths have been witnessed among Hispanics and other underserved populations in Massachusetts. Puerto Rican adults (PRs) have a disproportionately higher prevalence of chronic diseases than non-Hispanic White adults-conditions linked to increased prescription opioid use and misuse. Stress indicators, including low acculturation, low social support, and perceived discrimination, have been recognized as correlates of chronic diseases. However, little research has been undertaken on how these socio-cultural factors relate to persistent prescription opioid use among PRs. This study evaluated the prevalence of prescription opioid use and socio-cultural factors associated with persistent prescription opioid use among PRs.

METHODS

Data from the prospective population-based Boston Puerto Rican Health Study, at baseline, ~2-year, and ~ 6-year follow-up, were used to estimate prescription opioid use prevalence and its associations with acculturation, social support, and perceived discrimination. Analyses were conducted using multivariable binary logistic regression modeling.

RESULTS

The study sample was comprised of 798 PRs (age 56.5 ± 7.5y) with data at all three-time points. A high prevalence of prescription opioid use was observed and was associated with lower household income. PRs with experiences of perceived discrimination had higher odds of persistent prescription opioid use (y/n; OR = 2.85, 95% CI: 1.46-5.58). No significant associations were found between acculturation, social support, and persistent prescription opioid use.

CONCLUSION

Our study reported a high prevalence of prescription opioid use in PRs, with persistent prescription opioid use significantly associated with perceived discrimination. Future programs to limit discrimination practices may reduce persistent prescription opioid use and opioid-related complications among PRs.

Social connectedness and surviving at the margins: Findings from interviews with low-income Latino men in the U.S. Northeast

OBJECTIVES

Structural and interpersonal discrimination can lead to social exclusion and limited social integration, inhibiting the use of support networks to gain access to health-protective material and social resources. Social support theories suggest that connectedness may moderate the link between discrimination and health risk. This study examined how risk factors (i.e., structural and interpersonal discrimination) further marginalize Puerto Rican men by limiting access to social support. We also aimed to identify resiliency factors, such as cultural values related to social interactions and community support, which may be protective for these men's well-being.

METHOD

We conducted 40 semistructured interviews with a stratified purposeful sample of Puerto Rican (92.5%) men aged 25-70 (Mage = 50.7) in the U.S. Northeast. A hybrid deductive and inductive thematic qualitative analysis was used to analyze data.

RESULTS

Participants discussed how structural and interpersonal discrimination result in inequities and barriers to resources and services (e.g., lack of adequate shelter, insecurity, employment) which impacted their well-being through the inability to access fundamental support for survival. The men identified cultural values (e.g., familismo, simpatía) and emphasized the importance of community support as protective factors that may provide a respite from the difficulties of navigating discrimination experiences.

CONCLUSION

Findings suggest discrimination limits Puerto Rican men's ability to access resources, which has a detrimental impact on their well-being. Identifying social support beyond the family, and considering cultural values related to support, can enhance community interventions by focusing on incorporating multiple forms of support that may improve Puerto Rican men's health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Allostatic Load Using Bayesian Kernel Machine Regression

Background/Objective: This study aimed to investigate the effect of exposure to per- and polyfluoroalkyl substances (PFAS), a class of organic compounds utilized in commercial and industrial applications, on allostatic load (AL), a measure of chronic stress. PFAS, such as perfluorodecanoic acid (PFDE), perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), perfluoroundecanoic acid (PFUA), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHS), and metals, such as mercury (Hg), barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), molybdenum (Mo), lead (Pb), antimony (Sb), thallium (TI), tungsten (W), and uranium (U) were investigated. This research was performed to explore the effects of combined exposure to PFAS and metals on AL, which may be a disease mediator. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were used to conduct this study on persons aged 20 years and older. A cumulative index of 10 biomarkers from the cardiovascular, inflammatory, and metabolic systems was used to calculate AL out of 10. If the overall index was ≥ 3, an individual was considered to be chronically stressed (in a state of AL). In order to assess the dose-response connections between mixtures and outcomes and to limit the effects of multicollinearity and other potential interaction effects between exposures, Bayesian kernel machine regression (BKMR) was used. Results: The most significant positive trend between mixed PFAS and metal exposure and AL was revealed by combined exposure to cesium, molybdenum, PFHS, PFNA, and mercury (posterior inclusion probabilities, PIP = 1, 1, 0.854, 0.824, and 0.807, respectively). Conclusions: Combined exposure to metals and PFAS increases the likelihood of being in a state of AL.

Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study

Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health.

Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

Measuring allostatic load: Approaches and limitations to algorithm creation

OBJECTIVE

Allostatic load literature has proliferated over the past three decades, and a growing body of research demonstrates that higher levels of allostatic load are associated with a wide range of negative physical and mental health outcomes. However, there remain significant challenges with operationalization of the concept. A scoping review of the methods employed to create an allostatic load algorithm was conducted and recommendations for future research with an orientation towards advancing clinical application of the theory are discussed.

METHODS

A search of seven electronic databases (PubMed, PsycINFO, Social Work Abstracts, Social Service Abstracts, Social Sciences Citation Index (Web of Science), Sociological Abstracts, Scopus) was completed with the search term "allostatic load." Studies were reviewed, and if they met the inclusion criteria, data was extracted, complied, and presented in the narrative, table, and figures.

RESULTS

The initial searches yielded 5280 results with the final sample of 395 non-duplicate articles that met the inclusion criteria. More than half (52.5%) of all included publications employed biomarker cutoffs based on the high-risk quartiles of the sample distribution, 11.1% employed the sum of at-risk clinical scores, and the remainder of studies utilized a range of different algorithms.

CONCLUSION

Allostatic load literature has grown at an exponential rate in recent years, but researchers continue to operationalize the concept via algorithms that may have limited utility moving forward. More nuanced statistical approaches are emerging and should be considered, as should a shift towards an approach that can provide additional clinical utility.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults

BACKGROUND

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively.

METHODS

Data were from baseline, 2-year, and 5-year visits of 620 adults (45-75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0-60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8-15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0-2), moderate (3-5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score.

RESULTS

Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5-5.2)], but not depression-likely symptoms [4.5 (4.2-4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9-4.7)]. Baseline high AL [19.4 (17.6-21.2)], but not low AL [18.5 (16.5-20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3-18.5)].

CONCLUSIONS

Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

Dimensions of acculturation and biological dysregulation among Latina/os: the role of ethnic background, gender, and immigrant generation

Objective: Research examining how different dimensions of acculturative beliefs and behaviors influence the risk of biological dysregulation among Latina/os is limited. This study examined associations between three types of acculturation and allostatic load (i.e. a multisystem index of biological dysregulation) across gender and Latina/o ethnic groups. Multiplicative models were also included in order to determine whether immigrant generation moderates acculturation-allostatic load relationships.Design: Data were drawn from the Hispanic Community Health Study/ Study of Latina/os. The sample consisted of 11,841 Latina/os from five ethnic groups: Cuban, Puerto Rican, Dominican, Mexican, and South/Central American. The measure for allostatic load was derived from 15 biomarker and anthropometric measures that were designed to capture cardiometabolic risk, glucose metabolism, cardiopulmonary function, inflammation, and organ function. Acculturation measures, immigrant generation, gender, ethnic background, and other covariates were derived from self-reports. Survey corrected ordinary least squares regressions were used to assess relationships between different dimensions of acculturation and allostatic load.Results: Results demonstrate dimensions of acculturation play a significant role in the risk of biological dysregulation for Latina/os with divergent results across gender and ethnic background. Estimates from the multiplicative models show immigrant generation moderates acculturation-allostatic load relationships, and relationships are dependent on gender and ethnic background.Conclusion: The study contributes to the understanding of how different dimensions of acculturation, as well as other important structural determinants of health, influence the risk of biological dysregulation among Latina/os. Finding from this study can inform targeted strategies designed to reduce the physiological consequences of chronic stress among Latina/os.

Comparing different operationalizations of allostatic load measured in mid-life and their patterning by race and cumulative life course socioeconomic status

Since its conceptualization, there has been a lack of consensus on the best way to operationalize allostatic load (AL). As a marker of the cumulative, physiological wear and tear on the body resulting from chronic exposure to stressors, it follows that AL should be higher among people who have faced more stressful life experiences. Thus, the purpose of this study was to construct AL scores using different operationalizations and, as a measure of construct validity, compare whether each construction produced expected disparities in AL by race and a composite socioeconomic status (SES) variable which accounts for measures over the life course; we also explored differences by sex. We conducted the study in a sample of 45-52-year-old offspring from the Child Health and Development Studies, a longitudinal birth cohort established in the early 1960s. AL scores were constructed in 6 different ways and included 10 biomarkers from inflammatory, neuroendocrine, cardiovascular, and metabolic systems. Our main approach to constructing AL was to sum across high-risk biomarker quartiles, correct for medication use, and use sex-specific high-risk quartiles for specific biomarkers. Alternative constructions did not use sex-specific quartiles and/or weighted biomarkers within subsystems and/or did not correct for medication use. We estimated differences in AL scores by race, SES, sex and their pairwise interactions. All constructions of AL, including the main approach, produced expected disparities by race (higher scores for Black vs. non-Black participants) and life course SES (higher scores for low vs. high SES participants). However, disparities by sex only emerged when the AL score was constructed via approaches that did not use sex-specific high-risk quartiles; for these alternative constructions, overall, female participants had higher AL scores than male participants and Black female participants had the highest AL scores in the sample. For most constructions, the pairwise interaction between sex and SES, showed a stronger disparity in AL scores between low and high-SES female compared with low- and high-SES male participants; this suggests that, in terms of lowering AL, high life course SES may be more important for female than male participants. In conclusion, our results suggest that the basic AL concept is consistently expressed in different operationalizations, making it an especially useful and robust tool for understanding disparities by race and SES.

Demographic and Health Characteristics of Older Latino Birth Cohorts in the Health and Retirement Study

OBJECTIVES

Latinos are the fastest aging racial/ethnic minority group in the United States. One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos.

METHODS

We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of five entry birth cohorts of older Latinos aged 51-56 years (n = 2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the HRS birth cohorts.

RESULTS

Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity.

DISCUSSION

Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population.

The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population

A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.

Uncovering Historical Legacies to Contextualize Health Inequities in Puerto Rican Men: An Expansion of the Minority Stress Model

BACKGROUND

Low/no-income Latino men are disproportionately burdened by chronic disease morbidity and mortality, which is often compounded by persistent exposure to stress. Chronic stress is a key mediating factor in pathways linking macro-level socio-structural forces to micro-level behavioral factors with negative health outcomes. Being that Latinxs continue to be one of the fastest growing populations in the U.S., it is imperative to better understand the roots of stress pathways and explore multi-level interventions.

METHODS

This study presents qualitative findings from in-depth interviews with Puerto Rican men (95%) living in Springfield, Massachusetts. We utilized the Minority Stress Model (MSM) first posited by Ilan Meyers, as a framework to understand stress and stress processes amongst Puerto Rican men. We mapped our data onto Meyers' MSM, which allowed us to find diverging themes and identify areas for expansion.

RESULTS

As expected, participants reported stress rooted in experiences of racism and prejudice, expectations of rejection, English-language acquisition, family relationships, insecure housing, precarious employment, and lack of resources. Nevertheless, the MSM did not account for the historical contexts that, as our findings indicate, are used to filter and understand their experiences with everyday stressors. Participants described and linked histories of colonial violence and movement and migration to their stress and community wellbeing.

DISCUSSION

Findings suggest the need to expand the current MSM and our conceptualization of the stress process to include historical understandings when contextualizing present-day stress and future interventions. We propose an expanded heuristic model that delineates the impact of distinctive historical trajectories that aid in interpreting racial health disparities amongst minoritized populations. Future multi-level interventions should give weight to highlighting history and how this impacts the present, in this case including the culpability of U.S. policy regarding Puerto Rico and the adverse health effects for Puerto Rican men on the mainland.

Examination of the Allostatic Load Construct and Its Longitudinal Association With Health Outcomes in the Boston Puerto Rican Health Study

OBJECTIVE

Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability.

METHODS

Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing the presence of 21 dysregulated multisystem physiological parameters using the following: a) z scores, b) population-based quartile cutoffs, c) clinical-based cutoffs, d) 10 preselected clinical-based cutoffs (AL-reduced), and e) 12 clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment.

RESULTS

AL-quartile was associated with greater odds of T2D (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.07-1.35) and CVD (OR = 1.14; 95% CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95% CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95% CI = 1.07-1.21), IADL (OR = 1.11; 95% CI = 1.04-1.19), and ADL (OR = 1.15; 95% CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95% CI = 1.14-1.61), CVD (OR = 1.21; 95% CI = 1.11-1.32), IADL (OR = 1.15; 95% CI = 1.04-1.26), and ADL (OR = 1.24; 95% CI = 1.08-1.41). No associations were found with AL z-score.

CONCLUSIONS

AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Allostatic load, unhealthy behaviors, and depressive symptoms in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

The Environmental Affordances Model (EAM) proposes that the effects of chronic stress on depression are moderated by unhealthy behaviors and race/ethnicity. The unique social structures and contexts of Hispanics/Latinos in the U.S. may influence such relationships. This study evaluated whether unhealthy behaviors weakened the relationship between allostatic load, a measure of chronic stress, and future elevated depressive symptoms among Hispanic Community Health Study/Study of Latinos participants.

METHODS

Longitudinal data (2008-2011 and 2014-2017) from 11,623 participants were analyzed. The exposure was allostatic load, an index of twelve established biomarkers categorized using clinically relevant cut points, at Visit 1. Elevated depressive symptoms were operationalized as a score of ≥10 (out of 30) on the CES-D 10 at Visit 2. An index of unhealthy behaviors, with one point each for cigarette smoking, excessive/binge drinking, sedentary behavior, and poor diet quality at Visit 1, was examined as an effect modifier. Multivariable logistic regression, in the overall sample and among Mexicans specifically and adjusted for demographic characteristics and elevated depressive symptoms at Visit 1, was used to model allostatic load, unhealthy behavior index (range: 0-4), and their interaction in relation to elevated depressive symptoms at Visit 2.

RESULTS

Overall, greater allostatic load was associated with higher odds of elevated depressive symptoms after at least 6 years (aOR = 1.06, 95% CI = 1.01, 1.10). Overall, individuals with greater allostatic load and an unhealthy behavior index = 1, compared to those with an unhealthy behavior index = 0, had lower odds of elevated depressive symptoms at follow-up (aβ = -0.065, 95% CI = -0.12, -0.007).

CONCLUSIONS

The relationship between chronic stress and depression was partially moderated among Hispanics/Latinos who engaged in unhealthy behavior, which may have reduced their risk of elevated depressive symptoms given more chronic stress.

Stress and Allostatic Load Among Latina/os: Evidence from the Hispanic Community Health Study/Study of Latina/os

We investigated associations between measures of environmental and psychological stress (i.e., chronic stress and perceived stress) and allostatic load across gender. We also tested whether other important intersectional factors, such as ethnic background and nativity, moderated stress-allostatic load relationships. Data were drawn from the Hispanic Community Health Study/ Study of Latina/os, a representative, multi-ethnic sample of Latina/os living in four urban communities. The final analytic sample consisted of 3848 Latina/os from five ethnic groups: Cuban, Puerto Rican, Dominican, Mexican, and South/ Central American. Findings indicate greater chronic and perceived stress were significantly associated with allostatic load for males but not for females. We also find, in some cases, ethnic background and nativity moderated relationships between types of stress and allostatic load for males. Findings suggest that environmental and psychological stressors can potentially shape health profiles of Latino males, with important differences across ethnic background and nativity.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

INTRODUCTION

The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.

METHODS

Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.

RESULTS

Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.

CONCLUSIONS

Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.

Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load

Policy Points Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches. Targeted universalism, wellness-based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions. State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan.

CONTEXT

US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience.

METHODS

Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience.

FINDINGS

White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks.

CONCLUSIONS

Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.

Association of Family Member Detention or Deportation With Latino or Latina Adolescents' Later Risks of Suicidal Ideation, Alcohol Use, and Externalizing Problems

IMPORTANCE

Policy changes since early 2017 have resulted in a substantial expansion of Latino or Latina immigrants prioritized for deportation and detention. Professional organizations, including the American Academy of Pediatrics, American Medical Association, and Society for Research in Child Development, have raised concerns about the potentially irreversible mental health effects of deportations and detentions on Latino or Latina youths.

OBJECTIVE

To examine how family member detention or deportation is associated with Latino or Latina adolescents' later mental health problems and risk behaviors.

DESIGN, SETTING, AND PARTICIPANTS

Survey data were collected between February 14 and April 26, 2018, and between September 17, 2018, and January 13, 2019, and at a 6-month follow-up from 547 Latino or Latina adolescents who were randomly selected from grade and sex strata in middle schools in a suburban Atlanta, Georgia, school district. Prospective data were analyzed using multivariable, multivariate logistic models within a structural equation modeling framework. Models examined how family member detention or deportation within the prior 12 months was associated with later changes in suicidal ideation, alcohol use, and clinical externalizing symptoms, controlling for initial mental health and risk behaviors.

EXPOSURE

Past-year family member detention or deportation.

MAIN OUTCOMES AND MEASURES

Follow-up reports of suicidal ideation in the past 6 months, alcohol use since the prior survey, and clinical level of externalizing symptoms in the past 6 months.

RESULTS

A total of 547 adolescents (303 girls; mean [SD] age, 12.8 [1.0] years) participated in this prospective survey. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents whose parents provided permission. The 6-month follow-up retention rate was 81.5% (446 of 547). A total of 136 adolescents (24.9%) had a family member detained or deported in the prior year. Family member detention or deportation was associated with higher odds of suicidal ideation (38 of 136 [27.9%] vs 66 of 411 [16.1%]; adjusted odds ratio, 2.37; 95% CI, 1.06-5.29), alcohol use (25 of 136 [18.4%] vs 30 of 411 [7.3%]; adjusted odds ratio, 2.98; 95% CI, 1.26-7.04), and clinical externalizing behaviors (31 of 136 [22.8%] vs 47 of 411 [11.4%]; adjusted odds ratio, 2.76; 95% CI, 1.11-6.84) at follow-up, controlling for baseline variables.

CONCLUSION AND RELEVANCE

This study suggests that recent immigration policy changes may be associated with critical outcomes jeopardizing the health of Latino or Latina adolescents. Since 95% of US Latino or Latina adolescents are citizens, compromised mental health and risk behavior tied to family member detention or deportation raises concerns regarding the association of current immigration policies with the mental health of Latino and Latina adolescents in the United States.

Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. This study examined the association of an MSBR index with cancer mortality. The sample included n = 13,628 adults aged 20–90 from the NHANES III Linked Mortality File (1988–1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HOMA_ir, triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13–2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07–1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05–1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92–1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.

Biological Risk Profiles Among Latino Subgroups in the Health and Retirement Study

Background and Objectives

Latinos residing in the United States exhibit an increased risk for cardiovascular and metabolic diseases compared to non-Latino whites. This elevated risk contributes to a significantly higher prevalence of diabetes and hypertension among Latino adults. Examining biological risk profiles of older Latinos as a “pan-ethnic group” and by Latino subpopulations may help to explain the increased burden of disease in later life among this population. The objective of this study is to document biological risk profiles among a nationally representative sample of older U.S. Latinos by nativity and country of origin.

Research Design and Methods

We use the 2006–2012 Health and Retirement Study to compare cardiovascular, metabolic, inflammatory and cumulative biological risk among U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, U.S.-born “other” Latinos, foreign-born “other” Latinos, and non-Latino whites.

Results

Older Latinos exhibit heterogeneous biological risk profiles. U.S.-born Mexicans, foreign-born Mexicans, U.S.-born “other” Latinos, and foreign-born “other” Latinos exhibited a higher rate of cardiovascular risk relative to non-Latino whites. In addition, U.S.-born Mexicans, foreign-born Mexicans, island-born Puerto Ricans, and foreign-born “other” Latinos had a higher rate of metabolic risk than non-Latino whites. Island-born Puerto Ricans were the only group to exhibit higher inflammation than non-Latino whites. The observed differences were largely attenuated by socioeconomic status, indicating that high levels of risk among older Latino subpopulations compared to non-Latino whites are associated with lower socioeconomic status.

Discussion and Implications

Older U.S. Latinos are a demographically diverse population with unique sociocultural characteristics which may contribute to differences in biological risk across the life course that influence disease progression. Examining Latinos by nativity and country of origin may help identify risks specific to individual subpopulations that can lead to culturally appropriate interventions which help prevent and reduce the burden of cardiovascular and metabolic diseases.

Socioeconomic Adversity, Social Resources, and Allostatic Load Among Hispanic/Latino Youth: The Study of Latino Youth

OBJECTIVE

We examined associations among socioeconomic adversity, social resources, and allostatic load in Hispanic/Latino youth, who are at high risk for obesity and related cardiometabolic risks.

METHODS

Participants were 1343 Hispanic/Latino youth (51% male; ages 8-16 years) offspring of Hispanic Community Health Study/Study of Latinos participants. Between 2012 and 2014, youth underwent a fasting blood draw and anthropometric assessment, and youth and their enrolled caregivers provided social and demographic information. A composite indicator of allostatic load represented dysregulation across general metabolism, cardiovascular, glucose metabolism, lipid, and inflammation/hemostatic systems. Socioeconomic adversity was a composite of caregiver education, employment status, economic hardship, family income relative to poverty, family structure, and receipt of food assistance. Social resources were a composite of family functioning, parental closeness, peer support, and parenting style variables.

RESULTS

Multivariable regression models that adjusted for sociodemographic factors, design effects (strata and clustering), and sample weights revealed a significant, positive, association between socioeconomic adversity and allostatic load (β = .10, p = .035), and a significant, inverse association between socioeconomic adversity and social resources (β = -.10, p = .013). Social resources did not relate to allostatic load and did not moderate or help explain the association of adversity with allostatic load (all p values > .05).

CONCLUSIONS

Statistically significant, but small associations of socioeconomic adversity with both allostatic load and social resources were identified. The small effects may partially reflect range restriction given overall high socioeconomic adversity and high social resources in the cohort.

Disparities in functional disability among Arab Americans by nativity, immigrant arrival cohort, and country of birth

This study contributes to a growing literature that documents the importance of arrival cohort and country of birth for differentiating the health of U.S. immigrants. We use nationally-representative data from nine years of the American Community Survey (2008-2016) to examine if an immigrant health advantage exists among Arab Americans ages 40+ (n = 49,867) and test if differences among the foreign-born vary by arrival cohort (pre-1991, 1991-2000, and 2001+). Results from multivariate logistic regression models find that foreign-born Arab Americans have higher odds of physical and self-care disability, and this varies by immigrant arrival cohort. The post-2001 cohort had the highest odds of both disabilities, while the earlier two cohorts did not differ from the native-born after adjustments for covariates. Compositional differences in birthplace, particularly the large influx of immigrants from Iraq in the most recent cohort, explained these differences. Political instabilities globally have contributed to a growing number of U.S. immigrants with vulnerabilities that might be overlooked when arrival cohorts are not considered.

Allostatic Load: Importance, Markers, and Score Determination in Minority and Disparity Populations

Allostatic load is a physiological measure of the cumulative burden of stress on the body assessed by markers of physiological dysregulation. It is a multisystem construct that quantifies biological risk which leads to poor health and maladaptive trajectories. In this overview, which is based on a presentation made at the Flip the Script: Understanding African American Women's Resilience in the Face of Allostatic Load meeting at Ohio State University in August 2018, we build upon previous reviews by discussing four key aspects of allostatic load, specifically its: (1) importance, (2) operationalization, (3) use in minority health and health disparities research, and (4) value in such research. Operationalized in various ways, allostatic load is composed of 10 original markers and additional markers deriving from research among minority and disparity populations. The markers represent four biological systems: (1) cardiovascular, (2) metabolic, (3) inflammatory, and (4) neuroendocrine. System-specific racial/ethnic and sex-based differences have been observed. An overall score can be determined using sample-generated or empirically derived clinically relevant cut points. In summary, allostatic load provides an overall and a body system-specific mechanistic link between exposures to stressors and health outcomes that may help explain health disparities among minority populations.

Foreign-Born Hispanic Women's Health Patterns in Allostatic Load Converge to U.S.-Born Hispanic Women at a Slower Tempo Compared With Men

OBJECTIVES

We investigated the patterns of foreign-born Hispanic health convergence to U.S.-born Hispanics using an allostatic load index, a subjective biological risk health profile, and we explored whether the health convergence patterns differ by sex.

METHODS

The analytic sample consisted of 3,347 Hispanics from the pooled 2005-2010 National Health and Nutrition Examination Survey. We used negative binomial regression models to investigate the association between duration in the United States and the allostatic load index, while controlling for potential covariates.

RESULTS

Foreign-born Hispanics who had lived in the United States for 0-9 years and 10-19 years had lower levels of allostatic load than U.S.-born Hispanics; however, those who had lived in the United States for 20 or more years had a level of allostatic load similar to their U.S.-born counterparts. The pattern of immigrant health convergence shows a clear sex difference. In the sex-stratified models, we found that foreign-born Hispanic men converged to the level of allostatic load of U.S.-born Hispanic men after having lived in the United States for approximately 10 years. The health convergence pattern qualitatively differed for foreign-born Hispanic women, who remained healthier than U.S.-born Hispanic women regardless of duration in the United States.

CONCLUSIONS

Foreign-born Hispanics are healthier than their U.S.-born counterparts, providing support for the healthy migrant hypothesis. This relatively better health of foreign-born Hispanics disappears with a longer duration in the United States, providing support for the health convergence hypothesis, but is most noticeable for men. Foreign-born Hispanic women converge to U.S.-born Hispanic women's health status at a slower tempo, compared with foreign-born Hispanic men.

Hypertension Prevalence Jointly Influenced by Acculturation and Gender in US Immigrant Groups

BACKGROUND

Latinos and Asians in the United States are disproportionately burdened by hypertension, a leading risk factor for cardiovascular disease. Few studies have used multicomponent measures of acculturation to compare cardiovascular risk factors across immigrant-origin groups. Additionally, little is known about how acculturation and gender shape hypertension risk among immigrants.

METHODS

We created an acculturation score composed of language use, nativity, and years in the United States and fit separate race/ethnicity log-binomial models examining associations with hypertension prevalence (≥130/80 mm Hg) among Latino (n = 4,267) and Asian (n = 2,142) National Health and Nutrition Examination Survey 2011-2016 participants aged 18+. Joint effect models tested the concept of "intersectionality" between acculturation and gender.

RESULTS

Adjusting for age, gender, and socioeconomic position, Latinos and Asians with high acculturation were 25% and 27% more likely to have hypertension, respectively, compared with low acculturation groups. Latino and Asian American men with high levels of acculturation were 74-79% more likely to have hypertension compared with women with low acculturation (adjusted prevalence ratios (aPR) for Latinos = 1.74, 95% confidence interval (CI): 1.49-2.03; aPR for Asians = 1.79, 95% CI: 1.42-2.25). The gradient of increasing hypertension with increasing acculturation was most apparent among Latino men (adjusted risk differences (aRD) = 12.0%, P < 0.001) and Asian women (aRD = 14.0%, P = 0.003) and nonsignificant among Latino women and Asian men when comparing high vs. low acculturation categories.

CONCLUSIONS

Our results correspond with prior literature demonstrating increased morbidity among immigrants with increasing acculturation but also suggest differing patterns by race/ethnicity and gender. Future research should explore how migration processes differentially influence hypertension among men and women.

A Longitudinal Analysis of Allostatic Load among a Multi-Ethnic Sample of Midlife Women: Findings from the Study of Women's Health Across the Nation

OBJECTIVES

We examined longitudinal patterns and sociodemographic correlates of allostatic load (AL), a measure of cumulative biological risk and aging, in a sample of midlife women consisting of non-Hispanic White, African American, Chinese, and Japanese women.

METHODS

Longitudinal cohort data from the Study of Women's Health Across the Nation were used to examine AL patterns in midlife women ages 42-53 (n = 1,932). AL measures were created using 10 biomarkers representing cardiovascular, inflammatory, neuroendocrine, and metabolic system functioning. We used longitudinal random effects Poisson regression models to assess change in AL over the 7-year follow-up period and associations between sociodemographic factors and AL.

RESULTS

On average, a woman's AL score increased 2% each year over the course of the study. Baseline measures of African American race, low family income, older age, and ability to read and speak only in English were significantly associated with higher levels of AL over the study period. We did not observe significant differences in rates of change in AL by race/ethnicity or socioeconomic status.

CONCLUSIONS

This study demonstrates that AL increases in a cumulative manner as women age. Midlife is an especially important time in women's life course with respect to health maintenance and healthy aging. AL can be an early warning indicator of subsequent disease burden, pointing to subclinical conditions and the need for implementation of medical and public health interventions earlier in the disease process.

Migration Influences on the Allostatic Load of Children: Systematic Review Protocol

Background

Migration is a worldwide phenomenon in recent times. Recently, documented studies suggest that the change in environments involved in migration may have an influence on children’s allostatic load related to health and well-being.

Objective

The aim of this review is to systematically search the extant literature and critically examine the evidence on how migration affects allostatic load in children and describe the relevant methods in measuring allostatic load.

Methods

A systematic review will be conducted to recapitulate the evidence on the influence of migration on allostatic load and describe the methods employed in measuring allostatic load parameters among migrant children using the following search terms combinations: 1) allostasis OR allostatic OR allostatic load OR allosta*; 2) migration OR migrant OR immigration OR immigrant OR migra* OR *migra*; and 3) children OR child* OR adolescen*. We will search for peer-reviewed articles in English using a three-step process: title and abstract review, individual article review, and reference hand-searching among the following databases: Medline, CINAHL, ProQuest, PubMed, Science Direct and BioMed Central. Two independent review authors will analyze for data quality, level of evidence and risk of bias; a third review author will be consulted if consensus cannot be met. Data on study details, participant characteristics, allostatic load operationalization and description, methods, and results summary will be extracted. Evidence will be synthesized statistically when possible and narratively clustered into themes.

Results

At present, we have conducted only a preliminary search to test out our search terms. The systematic search, appraisal, synthesis and analysis will be finished by June 2018. It is projected that the manuscript that describes the systematic review will be available by the last quarter of 2018.

Conclusions

The results of this systematic review have implications on supporting the concept of allostasis as a mechanism underlying the adaptive processes related to migration. Furthermore, our findings can lead to the development of innovative evidence-informed evaluation and intervention programs aimed at migrant children's needs. Likewise, it is hoped that this review can be an impetus to inform health and sociopolitical policies responsive of migrant children's current contexts.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO): CRD42017068895; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68895 (Archived by WebCite at http://www.webcitation.org/6wprRkxvA)

Diurnal salivary cortisol and nativity/duration of residence in Latinos: The Multi-Ethnic Study of Atherosclerosis

Latino immigrants have lower prevalence of depression, obesity and cardiovascular disease than US-born Latinos when they are recently arrived in the US, but this health advantage erodes with increasing duration of US residence. Cumulative exposure to psychosocial stress and its physiological sequelae may mediate the relationship between nativity and duration of US residence and poor health. We used data from Latino cohort study participants ages 45-84 to examine cross-sectional (n=558) and longitudinal (n=248) associations between nativity and duration of US residence and features of the diurnal cortisol curve including: wake-up cortisol, cortisol awakening response (CAR, wake-up to 30min post-awakening), early decline (30min to 2h post-awakening) and late decline (2h post-awakening to bed time), wake-to-bed slope, and area under the curve (AUC). In cross-sectional analyses, US-born Latinos had higher wake-up cortisol than immigrants with fewer than 30 years of US residence. In the full sample, over 5 years the CAR and early decline became flatter and AUC became larger. Over 5 years, US-born Latinos had greater increases in wake-up cortisol and less pronounced flattening of the early diurnal cortisol decline than immigrants with fewer than 30 years of US residence. Immigrants with 30 or more years of US residence also had less pronounced flattening of the early decline relative to more recent immigrants, and also had a less pronounced increase in AUC. In sum, we saw limited cross-sectional evidence that US-born Latinos have more dysregulated cortisol than recently-arrived Latino immigrants, but over time US-born Latinos had slower progression of cortisol dysregulation.

Diverse Aging and Health Inequality by Race and Ethnicity

Although gerontologists have long embraced the concept of heterogeneity in theories and models of aging, recent research reveals the importance of racial and ethnic diversity on life course processes leading to health inequality. This article examines research on health inequality by race and ethnicity and identifies theoretical and methodological innovations that are transforming the study of health disparities. Drawing from cumulative inequality theory, we propose greater use of life course analysis, more attention to variability within racial and ethnic groups, and better integration of environmental context into the study of accumulation processes leading to health disparities.