Life Course Predictors of Allostatic Load Among LGBT Older Adults

Background and Purpose: Compared to older heterosexuals, lesbian, gay, bisexual, and transgender (LGBT) older adults are at significantly increased risk for poor mental and physical health. Such elevated risk is likely consequential to acute and chronic stressors specific to LGBT older adults’ marginalized social position. Allostatic load (AL) is the net effect of “wear and tear” on the body that results from chronic over-activation or repeated activation of the psychophysiological stress response system. Based on the Health Equity Promotion Model, the purpose of this study is to test potential life course predictors of AL among LGBT older adults, including financial constraints, interpersonal violence, legal marriage, and identity management.   

Methods: A subsample (n = 317) of LGBT adults aged 50 – 97 years old (M = 66.5; SD = 9.9) from Wave 1 (2014) of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) provided blood samples in the form of dried blood spots (DBS). From the DBS we constructed an AL assay comprised of blood pressure (diastolic & systolic); waist circumference; glycosylated hemoglobin; cholesterol ratio; C-reactive protein; and body mass index (BMI). A series of hierarchical linear regression models were tested to examine relationships between AL and financial constraints (childhood SES and current financial assets) [Model 1]; adding interpersonal violence (adult physical abuse, adult sexual abuse, and elder abuse) [Model 2]; legal marriage (lifetime opposite and same-sex marriage) [Model 3]; and identity management (age of first identity disclosure and identity stigma) [Model 4].

Results: Financial constraints were not associated with AL. Significant predictors in relation to AL in Model 2 were physical abuse during adulthood (b = .90, p < .05). In Model 3 physical abuse remained significant and lifetime opposite sex marriage (b = .47, p < .05) was significantly associated with AL whereas lifetime same sex marriage was not. When age of first identity disclosure (b = .02, p < .05) was added to Model 3, physical abuse (b = .91, p < .05) remained significant, but opposite sex marriage was no longer significant.

Conclusions and Implications: Although AL is linked to premature morbidity and mortality in the general population and among other health disparate groups (e.g., racial, ethnic minority populations), there has been a dearth of research examining AL within the LGBT population. This study found that adult physical abuse is associated with higher AL among LGBT older adults. The relationship between opposite-sex marriage and AL was explained by late identity disclosure for those who had been in an opposite-sex marriage. These findings provide preliminary support for increased research using a variety of biomarkers to study contextual, interpersonal, psychological, biological, and social risk and protective factors that contribute to biopsychosocial dysfunction, increased AL, and consequent premature morbidity and mortality among LGBT older adults.