2023
Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals
Donnelly, R., Garcia, M., Cha, H., Hummer, B., & Umberson, D. (2023). Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals. Demography. https://doi.org/10.1177/00221465221114485
Published online ahead of print on March 15, 2023.
Abstract: The present study documents differences in exposure to family member deaths among foreign-born and U.S.-born Hispanic individuals compared with non-Hispanic Black and non-Hispanic White individuals. We use data from the Health and Retirement Study (HRS; 1992–2016, ages 51+; N = 23,228) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Waves I–V, ages 12–43; N = 11,088) to estimate the risk of exposure to the death of a mother, father, spouse, sibling, and child across the life course. HRS results show more inequities in exposure to family deaths compared with Add Health results, suggesting differences by age or birth cohort. Compared with non-Hispanic Whites, U.S.-born Hispanic individuals in the HRS have a higher risk of experiencing a child’s death throughout adulthood and a sibling’s death in later life; the latter is explained by larger sibship size, indicating a greater lifetime risk of bereavement experiences. The higher risk of parental death during childhood for U.S.-born and foreign-born Hispanic individuals is explained by covariates (e.g., lower levels of educational attainment). Hispanic individuals generally have a lower risk of family deaths than non-Hispanic Black individuals, but at times a higher risk of exposure relative to non-Hispanic White individuals.
Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S.
Donnelly, R., Lin, Z., & Umberson, D. (2023). Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S. Social Forces. https://doi.org/10.1177/00221465221114485
Published online ahead of print on February 25, 2023
Abstract: Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998–2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress—an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent’s death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.
2022
Multiple family member deaths and cardiometabolic health among black and white older adults
Donnelly, R., Cha, H., & Umberson, D. (2022). Multiple family member deaths and cardiometabolic health among black and white older adults. Journal of Health and Social Behavior. https://doi.org/10.1177/00221465221114485
Published online ahead of print on August 05, 2022; available online through SAGE Journals
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.
The death of a child and parents’ psychological distress in mid to later life: Racial/ethnic differences in exposure and vulnerability
Umberson, D. & Donnelly, R. (2022). The death of a child and parents’ psychological distress in mid to later life: Racial/ethnic differences in exposure and vulnerability. The Journals of Gerontology: Series B, 77(8), 1561–1570. https://doi.org/10.1093/geronb/gbab206
Published online ahead of print on November 02, 2021; available online through Oxford Academic
Objectives: This study considered whether experiencing the death of a child is associated with subsequent psychological distress in older populations, as well as variation in both exposure and vulnerability to the death of a child among Black, Hispanic, and White older parents.
Methods: We used multilevel models to link the death of a child with subsequent distress for 9,763 non-Hispanic White, 2,496 non-Hispanic Black, 1,014 foreign-born Hispanic, and 712 U.S.-born Hispanic parents from the Health and Retirement Study, 2006-2016.
Results: The death of a child is associated with increased psychological distress in mid to later life for Black, White, and Hispanic parents, with greater vulnerability for foreign-born Hispanic parents. Notably, Black and U.S.-born Hispanic parents are disadvantaged because of the additive effects of their greater exposure to bereavement and their higher distress levels regardless of bereavement status. These effects persist net of additional stressors associated with race/ethnicity.
Discussion: The death of a child is a traumatic life course event associated with lasting psychological distress for aging parents. Black and U.S.-born Hispanic parents are disadvantaged in that they are more likely than White parents to experience the death of a child, and foreign-born Hispanic parents may be disadvantaged by greater vulnerability to distress following child death.
Sibling deaths, racial/ethnic disadvantage, and dementia in later life
Cha, H., Thomas, P. A., & Umberson, D. (2022). Sibling deaths, racial/ethnic disadvantage, and dementia in later life. The Journals of Gerontology: Series B, 77(8), 1539-1549. https://doi.org/10.1093/geronb/gbab202
Published online ahead of print on October 23, 2021; available online through Oxford Academic
Objectives: Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk.
Methods: We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000–2016). The sample includes 13,589 respondents (10,607 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline.
Results: Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults.
Discussion: The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.
Parental death and cognitive impairment: An examination by gender and race-ethnicity
Liu, H., Lin, Z., & Umberson, D. (2022). Parental death and cognitive impairment: An examination by gender and race-ethnicity. The Journals of Gerontology: Series B, 77(6), 1164-1176. https://doi.org/10.1093/geronb/gbab125
Published online ahead of print on July 07, 2021; available online through Oxford Academic
Objectives: We provide the first nationally representative longitudinal study of cognitive impairment in relation to parental death from childhood through early adulthood, midlife, and later adulthood, with attention to heterogeneity in the experience of parental death.
Methods: We analyzed data from the Health and Retirement Study (2000–2016). The sample included 13,392 respondents, contributing 72,860 person-periods. Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.
Results: Both exposure and timing of parental death were related to the risk of cognitive impairment in late life and associations vary by gender. The detrimental effect of a father’s death was comparable for daughters and sons although exposure to a mother’s death had stronger effects on daughter’s than son’s risk of cognitive impairment. Father’s death at younger ages had the strongest effect on sons’ late-life risk of cognitive impairment, whereas mother’s death in middle adulthood had the strongest effect on daughters’ risk. We found no significant racial-ethnic variation in the association between parental death and cognitive impairment.
Discussion: It is important to explore the gender-specific pathways through which parental death leads to increased risk of cognitive impairment so that effective interventions can be implemented to reduce risk.
2021
Racial differences in early parental death, midlife life problems, and relationship strain with adult children
Kim, Y. K., Kim, K., Fingerman, K. L., & Umberson, D. J. (2021). Racial differences in early parental death, midlife life problems, and relationship strain with adult children. The Journals of Gerontology Series B, 76(8), 1617–1628. https://doi.org/10.1093/geronb/gbaa232
Published online ahead of print on January 03, 2021; available online through Oxford Academic
Objectives: Black Americans typically experience the death of a parent earlier in the life course than do non-Hispanic Whites, and early parental death is known to hinder subsequent relationship outcomes. Whether early parental death may contribute to racial differences in midlife family relationships and the role midlife adults’ current life problems play remain unexplored.
Methods: Using multilevel modeling, we examined how timing of parental death is associated with relationship strain with adult children and whether the association differs by midlife adults’ life problems in Black (n = 166) and non-Hispanic White (n = 467) families from the Family Exchanges Study.
Results: Losing a parent in childhood was associated with more relationship strain with adult children for Black midlife adults, but not for their non-Hispanic White counterparts. Among the bereaved, earlier timing of parental death was associated with more relationship strain with adult children only for Black midlife adults. In both bereaved and nonbereaved sample, participants’ recent physical-emotional problems exacerbated the link between timing of parental death and relationship strain with adult children for Black midlife adults.
Discussion: Experiencing the death of a parent in the early life course can be an added structural disadvantage that imposes unique challenges for Black Americans in midlife. Policies and programs aimed at supporting bereaved children may benefit relationships with their own children later in life, and addressing physical-emotional problems in midlife may be a viable intervention point for those midlife adults who experienced the death of a parent in the early life course.
A national study of racial-ethnic differences in COVID-19 concerns among older Americans: Evidence from the Health and Retirement Study
Lin, Z. & Liu, H. (2021). A national study of racial-ethnic differences in COVID-19 concerns among older Americans: Evidence from the Health and Retirement Study. The Journals of Gerontology: Series B. https://doi.org/10.1093/geronb/gbab171
Published online ahead of print on September 21, 2021; available online through Oxford Academic
Objectives: Concerns about COVID-19 is an important emotional reaction to the pandemic and represents a key pandemic-related mental health outcome. We provide the first population-based evidence of racial-ethnic differences in COVID-19 concerns among older Americans during the COVID-19 outbreak.
Methods: We analyzed data from the 2020 Health and Retirement Study COVID-19 project. The sample included 2,879 respondents (aged 50 and older) who were interviewed from June to September 2020 and had completed measures on COVID-19 concerns and other key covariates. Ordinary least squares regression models were estimated to assess racial-ethnic differences in COVID-19 concerns. Formal mediation analysis was conducted to test potential mediating roles of exposures to COVID-19 risks, preexisting health status, and socioeconomic resources in accounting for racial-ethnic differences in COVID-19 concerns.
Results: Non-Hispanic Black and Hispanic Americans showed significantly greater concerns about the COVID-19 pandemic than non-Hispanic White Americans. Racial-ethnic minority older adults also had higher proportions of knowing someone who had contracted or died from COVID-19 than White older adults. Unequal exposures to COVID-19 risks by race-ethnicity and, to a lesser degree, preexisting health inequalities accounted for only part of the racial-ethnic differences in COVID-19 concerns.
Discussion: Our findings call for more research and policy interventions to lessen the disproportionate burden of COVID-19 experienced by older adults of racial-ethnic minority groups.
Trends in dementia prevalence, incidence, and mortality in the United States (2000–2016)
Farina, M. P., Zhang, Y. S., Kim, J. K., Hayward, M. D., & Crimmins, E. M. (2021). Trends in dementia prevalence, incidence, and mortality in the United States (2000–2016). Journal of Aging and Health. https://doi.org/10.1177/08982643211029716
Published online ahead of print on July 07, 2021; available online through SAGE Journals
Objectives: The prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Methods: Using the Health and Retirement Study (2000–2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. Results: The relative decline was about 2.4% per year for dementia prevalence and 1.9% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. Discussion: The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education.
Socioeconomic status across the life course and dementia-status life expectancy among older Americans
Cha, H., Farina, M. P., & Hayward, M. D. (2021). Socioeconomic status across the life course and dementia-status life expectancy among older Americans. SSM – Population Health, 15, 100921. https://doi.org/10.1016/j.ssmph.2021.100921
Available online on September 12, 2021; available online through ScienceDirect
Abstract: This study examines how socioeconomic status (SES) across the life course is associated with individuals’ lifetime dementia experience – the years of life persons can expect to live and without with dementia. Conceptually, dementia-free life expectancy reflects the ability to postpone dementia onset while dementia life expectancy reflects the average lifetime period with the condition. How SES across the life course contributes to dementia-status life expectancy is the focus of this study. We assess whether persons who are advantaged in their lifetime SES live the most years without dementia and the fewest years with dementia compared to less advantaged persons. Using the Health and Retirement Study (2000–2016), we examine these questions for U.S. adults aged 65 and older using multistate life tables and a microsimulation approach. The results show that higher SES persons can expect to live significantly more years of life without dementia and that the period of life with dementia is compressed compared to less advantaged persons. The results also underscore that importance of cumulative exposure, showing that adults from disadvantaged childhoods who achieve high education levels often have dementia experiences that are similar to or better than those of adults from advantaged childhoods who achieved low education levels.
The importance of improving educational attainment for dementia prevalence trends from 2000 to 2014, among older non-Hispanic Black and White Americans
Hayward, M. D., Mateo, P., Zhang, Y. S., Kim, J. K., & Crimmins, E. M. (2021). The importance of improving educational attainment for dementia prevalence trends from 2000 to 2014, among older non-Hispanic Black and White Americans. The Journals of Gerontology: Series B. https://doi.org/10.1093/geronb/gbab015
Published online ahead of print on January 22, 2021; available online through Oxford Academic
Objectives: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess (a) how the trends in dementia prevalence may have differed across age and race groups and (b) the role of changing educational attainment in understanding these trends.
Methods: This article estimates a series of logistic regression models using data from the Health and Retirement Study (2000–2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.
Results: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65–74 years had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.
Discussion: This study shows the importance of improvement in educational attainment in the early part of the twentieth century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.
2020
Family matters: Research on family ties and health, 2010 to 2020
Umberson, D. & Thomeer, M. B. (2020). Family matters: Research on family ties and health, 2010 to 2020. Journal of Marriage and Family, 82(1), 404–419. https://doi.org/10.1111/jomf.12640
Published online ahead of print on January 05, 2020; available online through Wiley Online Library
Abstract: Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status) and family dynamics and quality (e.g., emotional support from family members) on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another’s health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a “family biography” framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.
Death of a child prior to midlife, dementia risk, and racial disparities
Umberson, D., Donnelly, R., Xu, M., Farina, M., & Garcia, M. A. (2020). Death of a child prior to midlife, dementia risk, and racial disparities. The Journals of Gerontology Series B, 75(9), 1983–1995. https://doi.org/10.1093/geronb/gbz154
Published online ahead of print on November 24, 2019; available online through Oxford Academic
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Objectives: This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk.
Methods: We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000–2014.
Results: Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time.
Discussion: The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.
Marital status and dementia: Evidence from the Health and Retirement Study
Liu, H., Zhang, Z., Choi, S., & Langa, K. M. (2020). Marital status and dementia: Evidence from the Health and Retirement Study. The Journals of Gerontology: Series B, 75(8), 1783–1795. https://doi.org/10.1093/geronb/gbz087
Published online ahead of print on June 28, 2019; available online through Oxford Academic
Objectives: We provide one of the first population-based studies of variation in dementia by marital status in the United States.
Method: We analyzed data from the Health and Retirement Study (2000–2014). The sample included 15,379 respondents (6,650 men and 8,729 women) aged 52 years and older in 2000 who showed no evidence of dementia at the baseline survey. Dementia was assessed using either the modified version of the Telephone Interview for Cognitive Status (TICS) or the proxy’s assessment. Discrete-time hazard regression models were estimated to predict odds of dementia.
Results: All unmarried groups, including the cohabiting, divorced/separated, widowed, and never married, had significantly higher odds of developing dementia over the study period than their married counterparts; economic resources and, to a lesser degree, health-related factors accounted for only part of the marital status variation in dementia. For divorced/separated and widowed respondents, the differences in the odds of dementia relative to married respondents were greater among men than among women.
Discussion: These findings will be helpful for health policy makers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce dementia risk.
Widowhood and mortality: gender, race/ethnicity, and the role of economic resources
Liu, H., Umberson, D., & Xu, M. (2020). Widowhood and mortality: Gender, race/ethnicity, and the role of economic resources. Annals of Epidemiology, 45, 69-75.e1. https://doi.org/10.1016/j.annepidem.2020.02.006
Published online ahead of print on April 08, 2020; available online through ScienceDirect
Purpose: We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources.
Methods: Data were drawn from the Health and Retirement Study (1992–2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson–Holm–Breen analysis was conducted to examine the mediating role of economic resources across groups.
Results: Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics.
Conclusions: Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.
Race, death of a child, and mortality risk among aging parents in the United States
Donnelly, R., Umberson, D., Hummer, R. A., & Garcia, M. A. (2020). Race, death of a child, and mortality risk among aging parents in the United States. Social Science & Medicine, 249, 112853. https://doi.org/10.1016/j.socscimed.2020.112853
Published online ahead of print on February 13, 2020; available online through ScienceDirect
Abstract: The death of a child is a stressful and traumatic life event that has been linked to increased mortality risk among parents. Tragically, black parents are significantly more likely than white parents to lose a child in the United States; however, prior research has not addressed this racial disadvantage in relation to parents’ mortality risk. In this study, we focus on the racial context of the United States to suggest that black parents already face higher mortality rates compared to white parents, and the unequal burden of child death adds to their mortality risk. Using discrete-time event history models, we consider whether the death of a child by midlife is associated with increased mortality risk for black parents and for white parents in mid- to later-life using longitudinal data from the Health and Retirement Study (HRS; 1996–2016). Descriptive results show that by midlife, black parents, especially black mothers, experience substantially higher child mortality compared with white parents. At the same time, we find that losing a child prior to midlife is associated with heightened mortality risk for aging black mothers and white mothers. Controlling for educational attainment explains the association between child death and parental mortality risk among white mothers, whereas heightened biopsychosocial and behavioral risk factors explain the association for black mothers. Overall, the death of a child is associated with increased mortality risk for black mothers and for white mothers, but the processes linking child death to parental mortality seem to differ for black and white parents. These findings have implications for policies and interventions that address increased mortality risk for parents following the death of a child.
Family member death and subjective life expectancy among Black and White older adults
Donnelly, R., Umberson, D., & Pudrovska, T. (2020). Family member death and subjective life expectancy among Black and White older adults: Journal of Aging and Health, 32(3-4), 143-153. https://doi.org/10.1177/0898264318809798
Published online ahead of print on November 18, 2018; available online through SAGE Journals; and as a PDF
Objective: To examine whether exposure to family member deaths throughout the life course is associated with subjective life expectancy—a person’s assessment of their own mortality risk—at age 65, with attention to differences by race.
Method: We analyzed 11 waves of data from a study of men and women above age 50 (Health and Retirement Study; n = 13,973).
Results: Experiencing the deaths of multiple family members before the respondent is 50 years old is negatively associated with subjective life expectancy at age 65.
Discussion: Understanding the life-course predictors of older adults’ subjective life expectancy is particularly important because survival expectations influence long-term planning, health, and longevity. Moreover, Black Americans are exposed to more family member deaths earlier in their life compared with White Americans, with implications for long-term health and well-being.
Racial and educational disparities in dementia and dementia-free life expectancy
Farina, M. P., Hayward, M. D., Kim, J. K., & Crimmins, E. M. (2020). Racial and educational disparities in dementia and dementia-free life expectancy. The Journals of Gerontology: Series B, 75(7), 105–112. https://doi.org/10.1093/geronb/gbz046
Published online ahead of print on April 25, 2019; available online through Oxford Academic
Objectives: We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health.
Method: Based on the Health and Retirement Study (2000–2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race–education groups. The models also simulate group differences in the prevalence of dementia implied by these rates.
Results: The life table results document notable race–education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by 2 groups—blacks without a high school diploma and whites with some college or more.
Discussion: Dementia experience and dementia burden differ dramatically along race–education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population.
2019
Marital status and cognitive impairment in the United States: evidence from the National Health and Aging Trends Study
Liu, H., Zhang, Y., Burgard, S. A., & Needham, B. L. (2019). Marital status and cognitive impairment in the United States: Evidence from the National Health and Aging Trends Study. Annals of Epidemiology, 38, 28-34.e2. https://doi.org/10.1016/j.annepidem.2019.08.007
Published online ahead of print on August 21, 2019; available online through ScienceDirect
Purpose: We provide population-based longitudinal evidence of marital status differences in the risk of cognitive impairment and dementia in the United States.
Methods: Data were from the longitudinal National Health and Aging Trends Study, 2011–2018. The sample included 7508 respondents aged 65 years and older who contributed 25,897 person-year records. We estimated discrete-time hazard models to predict the risk of dementia and cognitive impairment, not dementia (CIND), as well as impairment in three major cognitive domains: memory, orientation, and executive function.
Results: Relative to their married counterparts, divorced and widowed elders had higher odds of dementia and CIND, as well as higher odds of impairment in each of the cognitive domains. Never-married elders had higher odds of impairment in memory and orientation than their married counterparts but did not differ significantly in the odds of impaired executive function, dementia, or CIND. Cohabiting elders did not differ significantly from married respondents on any measure of cognitive impairment. We found no gender differences in the associations between marital status and the measures of cognitive impairment.
Conclusions: Marital status is a potentially important but overlooked social risk/protective factor for cognitive impairment. Divorced and widowed older adults are particularly vulnerable to cognitive impairment.
2017
Black deaths matter: Race, relationship loss, and effects on survivors
Umberson, D. (2017). Black deaths matter: Race, relationship loss, and effects on survivors. Journal of Health and Social Behavior, 58(4), 405–420. https://doi.org/10.1177/0022146517739317
Published online ahead of print on November 06, 2017; available online through SAGE Journals; and as a PDF
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Abstract: Close relationships are a resource for mental and physical health that, like other social resources, is unequally distributed in the population. This article focuses on racial disparities in the loss of relationships across the life course. Racial disparities in life expectancy in the United States mean that black Americans experience the deaths of more friends and family members than do white Americans from childhood through later life. I argue that these losses are a unique type of stress and adversity that, through interconnected biopsychosocial pathways, contribute to disadvantage in health over the life course. I focus particularly on how the interconnected pathways associated with loss undermine opportunities for and increase risks to social ties throughout life, adding to disadvantage in health. I call on social scientists and policy makers to draw greater attention to this unique source of disadvantage for black children, adults, and families.
Death of family members as an overlooked source of racial disadvantage in the United States
Umberson, D., Olson, J. S., Crosnoe, R., Liu, H., Pudrovska, T., & Donnelly, R. (2017). Death of family members as an overlooked source of racial disadvantage in the United States. Proceedings of the National Academy of Sciences, 114(5), 915–920. https://doi.org/10.1073/pnas.1605599114
Published online ahead of print on January 23, 2017; available online through PNAS
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Abstract: Long-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.