Background. Socioeconomic status health disparities exist even in the oldest age groups. These disparities are only partially explained by differential prevalence of disease risk factors.
Objectives. This dissertation is the results of two related studies. The objectives of the first were to examine the extent to which perceived income inadequacy increased mortality risk in community dwelling older women, whether this risk was mediated by a cumulative index of biological dysregulation (allostatic load), and whether the relationship differed for African-American and Caucasian women. The objective of the second study was to investigate whether allostatic load was related to the frailty syndrome.
Design and methods. The first study used Cox proportional hazards modeling to estimate the effect of perceived income inadequacy and biological dysregulation on five-year mortality rates. The second study used ordinal logistic regression to examine the relationships between allostatic load and frailty in the baseline examination of two complementary population-based cohort studies.
Sample. Women's Health and Aging studies participants were drawn from a Medicare sampling frame of Eastern Baltimore City and county. This sample of 728 women had an age range of 70–79.
Findings. Forty four percent of women were robust, 46% were pre-frail, and 10% were frail. Allostatic load ranged from 0–8. For each one unit increase in income inadequacy, participants were almost 70% more likely to die in 5 years independent of age, education, absolute income, and race. For each increase in allostatic load, participants were 14% more likely to die. The effects of inadequate income and allostatic load were independent. The association between income inadequacy and mortality was stronger for African-Americans than for Caucasians. Further, each unit increase in allostatic load score was associated with increasing levels of frailty controlling for race, age, education, smoking, and co-morbidities.
Conclusions. Perception of adequacy of financial resources may be a better predictor of mortality than income, particularly for African-Americans. Future research could use income inadequacy as an additional measure of resources in older women. This dissertation also suggests that frailty is associated with allostatic load.
|Advisor:||Allen, Jerilyn K.|
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 68/04, Dissertation Abstracts International|
|Keywords:||Frailty, Mortality, Poverty, Stress, Women|
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