Abstract:

Understanding and eliminating health disparities continues to be one of the most pressing issues in public health research and practice. In particular, race/ethnicity and socioeconomic status (SES) have been major focal points of interest as potent predictors of morbidity and mortality differentials. Allostatic load (AL), an index of cumulative physiological dysregulation, has been recently developed to elucidate biological pathways by which individuals' interactions with their social environment are translated into health outcomes and disparities. This dissertation consists of three papers that examine AL among two samples of women: a nationally representative sample of adult women in the US from the National Health and Nutrition Examination Survey (NHANES) and a multiethnic community-based sample of midlife women undergoing the menopausal transition from the Study of Women Across the Nation (SWAN).

In the first paper, negative binomial regression models revealed that higher AL, indicative of greater cumulative physiological dysregulation, was significantly associated with older age, black race/ethnicity, lower SES, and US nativity among adult women. In addition, age-race interactions showed that midlife black women had higher AL scores than older white women. Predicted scores also revealed that foreign-born Mexican women had lower scores than US-born Mexican women. In the second paper, longitudinal random effects models with random intercept were employed to examine AL patterns over time. AL was found to increase with age, both at baseline and over the follow-up period in a sample of midlife women. AL was also associated with key sociodemographic variables; black and Hispanic race/ethnicity, lower SES, and US nativity were associated with higher AL. In the third paper, longitudinal ordered logistic regression models revealed AL to be a significant predictor of self-rated health net of sociodemographic and other health variables. Effects of education, income, nativity status, age, marital status, and menopausal status on self-rated health were also found to vary by race/ethnicity.

This dissertation provides descriptive sociodemographic profiles of AL among women and links AL to self-rated health, a commonly used health index. Allostatic load is a useful construct for better understanding patterns of health disparities and can potentially inform preventive health interventions and policies aimed at reducing health disparities.