Background
Methods
Study population
Measures
Primary determinants: race/ethnicity and toxic stress
Outcome measure: quality of life
Covariates
Data analysis
Results
Baseline characteristics
Characteristic | All Races (N = 3904) | White (N = 3159) | Black (A/A) (N = 574) | Other (N = 171) | p-value |
---|---|---|---|---|---|
N (%) | N (%) | N (%) | N (%) | ||
Age mean (SD) | 70.9 (9.3) | 71.6 (9.1) | 68.6 (8.7) | 66.5 (9.2) | < 0.0001 |
Female sex | 2009 (51.5) | 1548 (49.0) | 373 (65.0) | 88 (51.5) | < 0.0001 |
Marital Status | |||||
Married/ partnered | 2469 (63.2) | 2086 (66.0) | 278 (48.4) | 105 (61.4) | < 0.0001 |
Separated/Divorced | 442 (11.3) | 312 (09.9) | 109 (19.0) | 21 (12.3) | |
Widowed | 904 (23.2) | 701 (22.2) | 164 (28.6) | 39 (22.8) | |
Never married | 89 (02.3) | 60 (01.9) | 23 (04.0) | 06 (03.5) | |
Education | |||||
Less than High School/GED | 1150 (29.5) | 831 (26.3) | 243 (42.3) | 76 (44.4) | < 0.0001 |
High-school graduate | 1247 (31.9) | 1052 (33.3) | 166 (28.9) | 29 (17.0) | |
Some college and above | 1507 (38.6) | 1276 (40.4) | 165 (27.8) | 66 (38.6) | |
Disease conditions | |||||
Diabetes | 1934 (49.6) | 1440 (45.6) | 387 (67.4) | 107 (62.6) | < 0.0001 |
Heart Disease | 2525 (64.7) | 2155 (68.2) | 286 (49.8) | 84 (49.1) | < 0.0001 |
Diabetes & Heart Disease | 649 (16.9) | 516 (16.6) | 108 (19.2) | 25 (15.4) | 0.001 |
Behavioral factors | |||||
Ever smoked | 2363 (60.9) | 1925 (61.3) | 341 (60.0) | 97 (57.4) | 0.5366 |
Current alcohol use | 1773 (45.4) | 1540 (48.8) | 175 (30.5) | 58 (33.9) | < 0.0001 |
Life-course stressors | |||||
0 events | 734 (19.2) | 567 (18.3) | 129 (23.3) | 38 (23.0) | 0.0524 |
1 event | 1041 (27.2) | 857 (27.6) | 144 (26.0) | 40 (24.2) | |
2 events | 888 (23.2) | 737 (23.8) | 121 (21.8) | 30 (18.2) | |
3+ events | 1157 (30.3) | 940 (30.3) | 160 (28.9) | 57 (34.6) | |
Recent stressors | |||||
0 events | 3209 (82.2) | 2641 (83.6) | 443 (77.2) | 125 (73.1) | < 0. 0001 |
1 event | 533 (13.7) | 398 (12.6) | 105 (18.3) | 30 (17.5) | |
2+ events | 162 (04.1) | 120 (03.8) | 26 (04.5) | 16 (09.4) | |
Cumulative stressors | |||||
0 events | 662 (17.3) | 518 (16.7) | 111 (20.0) | 33 (20.0) | 0.2315 |
1 event | 937 (24.5) | 769 (24.8) | 133 (24.0) | 35 (21.2) | |
2 events | 878 (23.0) | 731 (23.6) | 115 (20.8) | 32 (19.4) | |
3+ events | 1343 (35.1) | 1083 (34.9) | 195 (35.2) | 65 (39.4) | |
Lifetime Discrimination | |||||
0 events | 2694 (70.0) | 2236 (71.6) | 348 (62.0) | 110 (65.1) | < 0.0001 |
1 event | 689 (17.9) | 559 (17.9) | 94 (16.8) | 36 (21.3) | |
2+ events | 468 (12.1) | 326 (10.5) | 119 (21.2) | 23 (13.6) | |
Everyday Discrimination | |||||
0 events | 1742 (45.0) | 1429 (45.6) | 238 (41.9) | 75 (44.4) | 0.2252 |
1 event | 1133 (29.3) | 914 (29.2) | 164 (28.9) | 55 (32.5) | |
2+ events | 994 (25.7) | 789 (25.2) | 166 (29.2) | 39 (23.1) | |
Chronic work Discrimination | |||||
0 events | 764 (84.9) | 600 (85.7) | 119 (81.5) | 45 (83.3) | 0.4782 |
1+ events | 136 (15.1) | 100 (14.3) | 27 (18.5) | 09 (16.7) | |
Self-rated health | |||||
Excellent | 865 (22.2) | 758 (24.0) | 81 (14.1) | 26 (15.2) | < 0.0001 |
Good | 1384 (35.4) | 1161 (36.8) | 171 (29.8) | 52 (30.4) | |
Poor | 1653 (42.4) | 1238 (39.2) | 322 (56.1) | 93 (54.4) |
Association of race on change in QOL
Odds Ratio (95% CI) | p-Value Race | p-Value T*Race | ||
---|---|---|---|---|
Race | Black/AA vs White/Caucasian | 1.46 (1.25, 1.70) | < 0.0001 | 0.6575 |
Other vs White/Caucasian | 1.43 (1.10, 1.86) | |||
Black/AA vs Other | 1.02 (0.76, 1.37) | |||
Toxic stressor types | Intensity of stressor | p-Value Stress | p-Value T*Stress | |
Everyday Discrimination | 0 vs 2+ Day discrimination | 0.92 (0.71, 1.18) | 0.8484 | 0.1960 |
1 vs 2+ Day discrimination | 0.95 (0.73, 1.25) | |||
Lifetime Discrimination | 0 vs 2+ Lifetime discrimination | 0.67 (0.50, 0.89) | 0.0111 | 0.0950 |
1 vs 2+ Lifetime discrimination | 0.83 (0.59, 1.17) | |||
Chronic work discrimination | 0 vs 1+ Work discrimination | 0.95 (0.51, 1.78) | 0.8948 | 0.4059 |
Association of toxic stress domains on SRH declines
2008 | 2010 | 2012 | 2014 | Stress | Time*Stress | Race*Time*Stress | |
---|---|---|---|---|---|---|---|
Toxic Stress Domain | Odds Ratio (95% CI) | Odds Ratio (95% CI) | Odds Ratio (95% CI) | Odds Ratio (95% CI) | P-value | P-value | P-value |
Recent Stressors | |||||||
Entire Sample Regardless of Race | |||||||
0 vs 2+ Recent stressors | 1.04 (0.68, 1.60) | 1.08 (0.67, 1.74) | 0.74 (0.44, 1.26) | 0.68 (0.37, 1.23) | 0.7799 | 0.359 | 0.0809 |
1 vs 2+ Recent stressors | 1.14 (0.70, 1.88) | 0.99 (0.57, 1.73) | 0.66 (0.37, 1.18) | 0.73 (0.37, 1.42) | |||
Among Older White Americans | |||||||
0 vs 2+ Recent stressors | 0.76 (0.53, 1.09) | 0.94 (0.65, 1.35) | 1.03 (0.70, 1.53) | 0.95 (0.63, 1.43) | 0.5461 | 0.1286 | n/a |
1 vs 2+ Recent stressors | 0.97 (0.66, 1.43) | 0.99 (0.66, 1.49) | 1.01 (0.65, 1.56) | 1.07 (0.67, 1.69) | |||
Among Older African Americans | |||||||
0 vs 2+ Recent stressors | 1.11 (0.51, 2.42) | 0.87 (0.36, 2.08) | 0.38 (0.15, 0.99) | 0.42 (0.14, 1.23) | 0.4727 | 0.033 | n/a |
1 vs 2+ Recent stressors | 0.77 (0.34, 1.79) | 0.79 (0.31, 2.02) | 0.40 (0.15, 1.10) | 0.56 (0.18, 1.77) | |||
Among Older Other race | |||||||
0 vs 2+ Recent stressors | 1.34 (0.51, 3.51) | 1.55 (0.52, 4.57) | 1.02 (0.30, 3.49) | 0.81 (0.21, 3.16) | 0.6733 | 0.5895 | n/a |
1 vs 2+ Recent stressors | 2.00 (062, 6.43) | 1.26 (0.34, 4.65) | 0.70 (0.18, 2.82) | 0.64 (0.13, 3.11) | |||
Life-course stressors | |||||||
Entire Sample Regardless of Race | |||||||
0 vs 3+ life-course stressors | 0.81 (0.59, 1.12) | 0.79 (0.55 1.12) | 0.77 (0.53, 1.12) | 0.62 (0.42, 0.92) | 0.1863 | 0.1227 | 0.1173 |
1 vs 3+ life-course stressors | 0.67 (0.49, 0.92) | 0.97 (0.69, 1.35) | 0.94 (0.67, 1.32) | 0.69 (0.48, 0.99) | |||
2 vs 3+ life-course stressors | 0.87 (0.62, 1.22) | 0.95 (0.67, 1.36) | 0.84 (0.57, 1.19) | 0.63 (0.42, 0.95) | |||
Among Older White Americans | |||||||
0 vs 3+ life-course stressors | 0.76 (0.62, 0.92) | 0.78 (0.64, 0.97) | 0.73 (0.58, 0.91) | 0.86 (0.68, 1.10) | 0.0063 | 0.6654 | n/a |
1 vs 3+ life-course stressors | 0.72 (0.61, 0.87) | 0.79 (0.66, 0.96) | 0.71 (0.58, 0.87) | 0.85 (0.68, 1.09) | |||
2 vs 3+ life-course stressors | |||||||
0.80 (0.66, 0.96) | 0.92 (0.76, 1.12) | 0.86 (0.69, 1.07) | 0.98 (0.78, 1.24) | ||||
Among Older African Americans | |||||||
0 vs 3+ life-course stressors | 0.88 (0.56, 1.42) | 0.69 (0.43, 1.12) | 0.48 (0.29, 0.79) | 0.47 (0.27, 0.83) | 0.0828 | 0.3159 | n/a |
1 vs 3+ life-course stressors | 0.75 (0.46, 1.20) | 0.72 (0.45, 1.15) | 0.73 (0.44, 1.20) | 0.59 (0.33, 1.04) | |||
2 vs 3+ life-course stressors | 0.72 (0.45, 1.14) | 0.83 (0.51, 1.36) | 0.80 (0.47, 1.35) | 0.72 (0.41, 1.26) | |||
Among Older Other race | |||||||
0 vs 3+ life-course stressors | 0.80 (0.35, 1.83) | 0.90 (0.35, 2.27) | 1.24 (0.46, 3.33) | 0.59 (0.22, 1.61) | 0.9943 | 0.0204 | n/a |
1 vs 3+ life-course stressors | 0.55 (0.25, 1.23) | 1.58 (0.67, 3.75) | 1.58 (0.66, 3.75) | 0.66 (0.27, 1.65) | |||
2 vs 3+ life-course stressors | 1.15 (0.48, 2.77) | 1.12 (0.44, 2.86) | 0.83 (0.33, 2.04) | 0.36 (0.12, 1.04) | |||
Cumulative stressors | |||||||
Entire Sample Regardless of Race | |||||||
0 vs 3+ Cumulative stressors | 0.83 (0.60, 1.15) | 0.76 (0.54, 1.08) | 0.75 (0.51, 1.11) | 0.68 (0.45, 1.01) | 0.361 | 0.1035 | 0.0282 |
1 vs 3+ Cumulative stressors | 0.77 (0.56, 1.07) | 1.24 (0.89, 1.74) | 1.06 (0.74, 1.51) | 0.86 (0.59, 1.24) | |||
2 vs 3+ Cumulative stressors | 0.95 (0.69, 1.32) | 1.03 (0.73, 1.46) | 0.85 (0.61, 1.19) | 0.83 (0.56, 1.23) | |||
Among Older White Americans | |||||||
0 vs 3+ Cumulative stressors | 0.73 (0.60, 0.89) | 0.79 (0.64, 0.98) | 0.78 (0.62, 0.98) | 0.82 (0.65, 1.05) | 0.0091 | 0.8348 | n/a |
1 vs 3+ Cumulative stressors | 0.74 (0.62, 0.88) | 0.79 (0.66, 0.96) | 0.76 (0.62, 0.92) | 0.89 (0.71, 1.11) | |||
2 vs 3+ Cumulative stressors | 0.83 (0.70, 0.99) | 0.94 (0.78, 1.14) | 0.92 (0.74, 1.13) | 0.98 (0.79, 1.23) | |||
Among Older African Americans | |||||||
0 vs 3+ Cumulative stressors | 1.04 (0.65, 1.66) | 0.69 (0.43, 1.11) | 0.44 (0.27, 0.74) | 0.45 (0.26, 0.79) | 0.0934 | 0.1424 | n/a |
1 vs 3+ Cumulative | 0.84 (0.53, 1.33) | 0.83 (0.53, 1.31) | 0.71 (0.43, 1.16) | 0.56 (0.32, 0.97) | |||
stressors | |||||||
2 vs 3+ Cumulative stressors | 1.04 (0.66, 1.63) | 0.91 (0.56, 1.48) | 0.76 (0.46, 1.26) | 0.82 (0.46, 1.44) | |||
Among Older Other race | |||||||
0 vs 3+ Cumulative stressors | 0.76 (0.33, 1.75) | 0.82 (0.33, 2.02) | 1.34 (0.54, 3.29) | 0.83 (0.29, 2.33) | 0.452 | 0.0973 | n/a |
1 vs 3+ Cumulative stressors | 0.75 (0.33, 1.72) | 2.93 (1.22, 7.08) | 2.23 (0.90, 5.55) | 1.27 (0.51, 3.20) | |||
2 vs 3+ Cumulative stressors | 1.00 (0.43, 2.33) | 1.28 (0.52, 3.17) | 0.89 (0.38, 2.08) | 0.72 (0.26, 1.98) |