Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults

Abstract

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992–2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

Familial Loss of a Loved One and Biological Aging

“…Several studies have highlighted significant disparities in loss among Black and Hispanic populations compared with White populations in the US. 3 , 6 , 14 , 40 , 41 , 42 , 43 Consistent with recent work by Donnelly et al, 14 we noted that Hispanic participants experienced a higher number of losses than White non-Hispanic participants. American Indian and Pacific Islanders also experienced greater loss, but the sample size for these estimates were small.…”

“…Racial and ethnic disparities exist in the frequency and nature of losing loved ones, often due to racism and a history of disadvantage. 3 , 6 , 40 , 41 , 42 , 43 Race is not a biological factor and while race itself is not racism, it is a sociopolitical and contextual construct linked to greater exposure to adverse environments and health disadvantages from a history of oppression. 44 , 45 , 46 , 47 , 48 Furthermore, clocks, mainly developed in predominantly White samples, show varying sensitivities to social and environmental exposures across different races.…”

“… 2 , 3 , 4 , 5 Nonetheless, the death of a close family member at any age poses health risks, such as heightened cardiovascular, mortality, and dementia risks in adulthood. 1 , 6 , 7 , 8 Repeated family losses over one’s life further compound these health risks. 6 The impacts of loss may persist or become apparent long after the event.…”

“… 1 , 6 , 7 , 8 Repeated family losses over one’s life further compound these health risks. 6 The impacts of loss may persist or become apparent long after the event. 5 , 6 , 8 , 9 …”

“…To address existing gaps, we investigated if familial loss and quantity of loss, occurring either in early life or adulthood, were associated with biological aging in a diverse, population-based sample. Acknowledging prior research on racial disparities in loss experiences and variability in exposure histories, 6 , 14 we also examined the interaction between loss and race on biological aging. We analyzed survey responses from waves 1 to 5 of the National Longitudinal Study of Adolescent to Adult Health (Add Health), coupled with new epigenetic data from wave 5.…”