Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016

Allan K. Nkwata, Ming Zhang, Xiao Song, Bruno Giordani and Amara E. Ezeamama
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Allan K. Nkwata: Survey Research Center, Institute of Social Research, University of Michigan, Ann Arbor, MI 48106, USA
Ming Zhang: Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA
Xiao Song: Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA
Bruno Giordani: Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
Amara E. Ezeamama: Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA

IJERPH, 2022, vol. 19, issue 4, 1-18

Abstract: Background: Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a nationally representative sample ( n = 6516) of American adults ≥50 years enrolled in the Health and Retirement Study between 2006 and 2016. Methods: TS included experiences of everyday discrimination and RPF included personal mastery. Race/ethnicity was self-reported as African American, Caucasian, or Other. Multivariable Cox proportional hazards regression models estimated TS-, RPF- and race-associated hazard ratios (HR) for dementia diagnosis and 95% confidence intervals (CIs) with adjustment for comorbidity, lifestyle, and socio-demographic confounders. Results: Discrimination-associated risk of dementia diagnosis on average increased with education level [discrimination x education, p = 0.032; HR = 1.75 (95% CI: 1.01–3.03) if < high school, HR = 5.67 (95% CI: 2.94–10.94) if high school completed and HR = 2.48 (95% CI: 1.53–4.00) if ≥some college education]. Likewise, African American vs. Caucasian race disparity in new-onset dementia was evident (HR = 2.12, 95% CI: 1.42–3.17) among adults with high-mastery while absent (HR = 1.35, 95% CI: 0.75–2.41) among adults with low mastery (Mastery x Race, p = 0.01). Conclusions: TS is a contextual driver of incident dementia that seemingly operates in a race and RPF-dependent fashion among American adults. Association pattern suggests that TS may overwhelm the cognitive reserve benefit of RPF particularly in status-inconsistent contexts including persons subjected to discrimination despite high education and persons of African American descent despite high mastery. Policies that reduce discrimination and promote equitable treatment by race/ethnicity may support cognitive resiliency and reduce the risk of dementia diagnosis in adult Americans.

Keywords: toxic stress; resilience-promoting factors; incident dementia; everyday discrimination; older Americans (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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