| Abstract | Background: 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 (timestressrace, p=0.1173). Specifically, increasing
lifetime stress predicted greater QOL decline among Caucasians (p=0.0063) and among AfricanAmerican (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.
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