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Abstract
Background: The toxic stress (TS), resilience promoting factors (RPF), minority race and their interactions were evaluated as determinants of quality of life (QOL) and neurocognitive decline in a nationally representative sample of American adults ≥ 50 years with heart disease (HD) and/or type-2 diabetes (T2DM) diagnosed by 2006 as part of the Health and Retirement Study (HRS). Methods: Data used were from the HRS 2006-2016. In Aim 1, we examined TS and conducted additional analyses within strata of racial groups to understand possible variations in TS and relationship with wellbeing (QOL) over 8 years of follow-up. In aim 2, first we examined whether TS and RPF were associated with neurocognitive impairment (NI) in our sample. We further examined whether TS and RPFs were associated with dementia incidence starting with dementia-free adults followed longitudinally from 2006-2016.
Results: The odds of declining SRH for African-Americans and Other race were respectively 1.46 (95% CI: 1.25–1.70) and 1.43 (95% CI: 1.10–1.86) times higher relative to Caucasian race over 8 years. The odds of SRH decline were respectively 33% (OR=0.67, 95% CI: 0.50–0.89) and 17% (95% CI: 0.59–1.17) lower for individuals that experienced <2 lifetime vs. ≥2 lifetime discrimination events. Furthermore, the relationship of life course stress to SRH decline over eight years varied by race (time*stress*race, p=0.1173). Specifically, increasing lifetime stress predicted greater QOL decline among Caucasians (p=0.0063) and among African-American (p=0.0820) but not among Other race (p=0.9943). Similarly, chronic stress (OR 1.31, 95%CI: 1.01, 1.70) and discrimination (OR 2.51, 95% CI: 1.75, 3.59) were associated with higher NI risk while high vs. low mastery (OR 0.61, 95%CI: 0.47, 0.77) was associated with lower NI risk. High vs. low mastery-associated lower NI risk was evident among adults that denied experiencing discrimination (OR 0.57, 95%CI: 0.44, 0.74) but not among those that reported experience of discrimination (OR 0.93, 95%CI: 0.47, 1.81). Relative to White/Other race, African American race was associated with NI risk but only in the sub-group that achieved high mastery (OR 1.83, 95%CI: 1.20, 2.80).
Conclusion: Toxic stress and minority race are social determinants of QOL and NI declines among older Americans in this study. The types and prevalence of toxic stressors varied according to race/ethnicity. Policy interventions to address the root causes TS represent a viable strategy for mitigating racial disparities in overall wellbeing and improving health outcomes in all aging Americans regardless of race.