Disparities and Differences in Physiological Distress Among Black and White Men in the US

Background and Purpose:

Black men have poorer health and shorter average lifespans than the rest of the U.S. population, in large part due to disparities in chronic disease. Researchers posit that exposure to social inequities may cause members of marginalized groups, including Black men, to experience chronic physiological distress, which is increasingly being investigated as a key precursor of chronic disease and a mechanism through which racial health disparities are generated and reproduced.

Physiological distress is the activation and disruption of the healthy functioning of biological systems involved in the stress response. Biomarkers of physiological distress, such as cortisol, can be used to examine the cumulative effects of chronic physiological distress on the body. These objective measures of distress may be especially beneficial for understanding health disparities among men because they capture the deleterious effects of stressors that can go undetected (e.g., institutional discrimination) and may more accurately capture distress among men, who often self-report low levels of distress.

Several characteristics of Black men, including their race, gender, exposure to stressful conditions, and disproportionate burden of morbidity and mortality, are associated with chronic physiological distress. Yet, more empirical research is needed to ascertain if Black men do, in fact, manifest more physiological distress than other demographic groups. It is also unknown whether stress and coping mechanisms associated with physiological distress function universally or if they differ by race. The purpose of this study is to explore racial differences in patterns and predictors of physiological distress among men.

Methods:

This study used data from Black and White male participants in the National Survey of Midlife Development in the United States (MIDUS) II who provided salivary cortisol samples. I documented patterns of physiological distress among Black and White men and tested whether race moderated the relationships between physiological distress and key predictors of physiological distress: psychological distress, functional limitations, and number of existing health problems. I assessed physiological distress using diurnal cortisol slopes from peak to midday, averaged over four days to increase stability.

Results:

Black men manifested more chronic physiological distress than White men. Racial disparities in the magnitude of men’s physiological distress may be partly attributable to differences in the functioning of underlying stress mechanisms: Black men with health problems manifested more distress than similar White men.

Conclusions and Implications:

This study fills a critical gap in research positing chronic physiological distress as a key mechanism of health disparities affecting Black men. Findings suggest that race-based differences in men’s physiological distress are due at least in part to differences in underlying stress mechanisms and not solely differences in the magnitude of risk and protective factors. This has important implications for intervention, as it indicates the need for adopting a targeted approach—developing a better understanding of the functioning of stress mechanisms among Black men, how these may differ compared to other groups, and critical junctures for interrupting stress processes contributing to Black men’s poor health outcomes.