Everyday Instances of Unfair Treatment, Race/Ethnicity, and Cumulative Biological Risk Among Older Adults: Evidence from the Health and Retirement Study

Background/Purpose: The aim of this study is to examine how everyday instances of unfair treatment relate to cumulative biological risk among older adults, and whether this  relationship varies by race/ethnicity.  Understanding how chronic psychosocial stressors such as everyday instances of unfair treatment (i.e., relatively minor or even trivial day-to-day hassles, slights, or insults) relate to cumulative biological risk across multiple physiological systems reflects the aggregate physiological toll that exerted on the body through experiences with chronic stressors (McEwen and Seeman, 1999).  Prior research has shown that cumulative measures of biological risk predict incident cardiovascular disease and all-cause mortality throughout the lifecourse (Karlamangla et al. 2002; Seeman et al. 1997; Seeman et al.  2001).  Given that older racial/ethnic minority groups report greater exposure to everyday instances of unfair treatment (Barnes et al., 2004; Forman et al., 1997; Kessler et al., 1999; Lewis et al., 2012), understanding how everyday instances of mistreatment related to multisystem biological risk  and race/ethnicity combine to shape biological risk among older adults may provide us some insight into ongoing racial/ethnic health disparities among older adults. 

Methods: Data and samples :Cross-sectional data from the Health and Retirement Study, a nationally representative, ongoing, longitudinal study designed to be representative of the U.S. population over 50 years of age, was used to examine the interplay between everyday instances of unfair treatment, race/ethnicity, and cardiometabolic risk.  Our analytic sample included 10,084 adults over the age of 51 who were interviewed in 2006/2008.  Measures: Our measure of cumulative biological risk is based on seven biological indicators of cardiovascular, inflammatory, and metabolic physiological functioning that are known to predict health and mortality among older adults. Our focal predictor, everyday instances of unfair treatment, derives self-reports. An interaction term for chronic exposure to everyday instances of unfair treatment and race/ethnicity was used to test for moderation.

Results: Higher exposure to everyday instances of unfair treatment significantly predicted higher levels of cardiometabolic risk among older adults before and after adjusting for race/ethnicity, sex, education, marital status, household income, and other covariates (IRR: 1.04, 95% CI: 1.02 - 1.07). We also included an interaction term (everyday instances of unfair treatment x race/ethnicity) to investigate whether the health related consequences of experiencing everyday instances of unfair treatment varied by race/ethnicity, and found that Blacks who reported higher exposure to everyday instances of unfair treatment had fewer biomarkers in the high risk category than those who did not (IRR: 0.93; 95% CI: 0.89 - 0.99).

Conclusions and Implications: This was one of the first studies to investigate the interplay between chronic exposure to unfair treatment, race/ethnicity, and cardiometabolic risk among older adults.   Our findings add to a growing body of research on the effects of chronic exposure to unfair treatment as an important social determinant of health among older adults.