Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities

Introduction: Allostatic load (AL) is a significant fi cant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. Methods: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. Results: Having a college degree or more (b =- 0.32; 95% CI:- 0.46,- 0.17), higher income (b =- 0.06; 95% CI:- 0.11,- 0.01), and greater wealth (b =- 0.11; 95% CI:- 0.16,- 0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. Conclusions: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities. Am J Prev Med 2024;67(1):97-104. - 104. (c) 2024 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.