Race and Ethnicity Moderates the Relationship Between Family Income Level and Allostatic Load Among Adolescents in the United States

Purpose: People from low-income households are at risk of high allostatic load (AL) in adulthood, which is linked to poor physical and mental health outcomes. It is unclear how early the income-AL link develops and whether this association differs by race and/or ethnicity. We examined associations of family income with high AL among adolescents and whether race and/or ethnicity modified associations. Methods: Cross-sectional, nationally representative data came from 748 US adolescents (aged 12-17 years) who participated in the prepandemic 2017-March 2020 National Health and Nutrition Examination Survey. Family income was measured using poverty-income ratio (PIR) and categorized as low income (PIR <1.0), middle income (PIR 1.0-4.0), and high income (PIR >4.0). AL was derived from 9 biomarkers. Modified Poisson regression models estimated prevalence ratios (PRs) for associations of family income with high AL overall and stratified by race and/or ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). Results: Nearly 1 in 5 adolescents (19.7%) met the criteria for high AL. Compared to high-income peers, middle-income adolescents had more than twice the prevalence of high AL (PR: 2.16; 95% confidence interval: 1.13-4.13), and low-income adolescents had nearly triple the prevalence of high AL (PR: 2.98; 95% confidence interval: 1.76-5.04). Stratified models observed these associations only for non-Hispanic White adolescents, while for non-Hispanic Black and Hispanic youth, associations were attenuated and nonsignificant. Discussion: Higher family income was protective against high AL only for non-Hispanic White adolescents. Minority youth may face additional stressors that diminish the protective effects of higher income. (c) 2025 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).