Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

Published:December 14, 2020DOI:


      The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.


      Data were from 26,818 adult participants in the 2005–2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.


      Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005–2006 to 3.02 in 2017–2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.


      Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.
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        • Braveman P
        • Egerter S
        • Williams DR
        The social determinants of health: coming of age.
        Annu Rev Public Health. 2011; 32: 381-398
        • Williams DR
        • Neighbors HW
        • Jackson JS
        Racial/ethnic discrimination and health: findings from community studies.
        Am J Public Health. 2003; 93: 200-208
        • Williams DR
        • Collins C
        Racial residential segregation: a fundamental cause of racial disparities in health.
        Public Health Rep. 2001; 116: 404-416
        • Kessler RC
        • Mickelson KD
        • Williams DR
        The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.
        J Health Soc Behav. 1999; 40: 208-230
        • Williams DR
        • Yan Yu
        • Jackson JS
        • Anderson NB
        Racial differences in physical and mental health: socio-economic status, stress and discrimination.
        J Health Psychol. 1997; 2: 335-351
        • Link BG
        • Phelan J.
        Social conditions as fundamental causes of disease.
        J Health Soc Behav. 1995; : 80-94
        • Bailey ZD
        • Krieger N
        • Agénor M
        • Graves J
        • Linos N
        • Bassett MT
        Structural racism and health inequities in the USA: evidence and interventions.
        Lancet. 2017; 389: 1453-1463
        • Seabrook JA
        • Avison WR.
        Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes.
        Can Rev Sociol. 2012; 49: 50-68
        • Ferraro KF
        • Shippee TP
        Aging and cumulative inequality: how does inequality get under the skin?.
        Gerontologist. 2009; 49: 333-343
        • Shuey KM
        • Willson AE.
        Cumulative disadvantage and Black-White disparities in life-course health trajectories.
        Res Aging. 2008; 30: 200-225
        • Viruell-Fuentes EA
        • Miranda PY
        • Abdulrahim S
        More than culture: structural racism, intersectionality theory, and immigrant health.
        Soc Sci Med. 2012; 75: 2099-2106
        • Lara M
        • Gamboa C
        • Kahramanian MI
        • Morales LS
        • Bautista DE
        Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context.
        Annu Rev Public Health. 2005; 26: 367-397
        • Markides KS
        • Coreil J
        The health of Hispanics in the southwestern United States: an epidemiologic paradox.
        Public Health Rep. 1986; 101: 253-265
        • John DA
        • de Castro AB
        • Martin DP
        • Duran B
        • Takeuchi DT
        Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders.
        Soc Sci Med. 2012; 75: 2085-2098
        • Acevedo-Garcia D
        • Bates LM
        • Osypuk TL
        • McArdle N
        The effect of immigrant generation and duration on self-rated health among U.S. adults 2003-2007.
        Soc Sci Med. 2010; 71: 1161-1172
        • Abraído-Lanza AF
        • Chao MT
        • Flórez KR
        Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox.
        Soc Sci Med. 2005; 61: 1243-1255
        • Duong MT
        • Bingham BA
        • Aldana PC
        • Chung ST
        • Sumner AE
        Variation in the calculation of allostatic load score: 21 examples from NHANES.
        J Racial Ethn Health Disparities. 2017; 4: 455-461
        • Rodriquez EJ
        • Livaudais-Toman J
        • Gregorich SE
        • Jackson JS
        • Nápoles AM
        • Pérez-Stable EJ
        Relationships between allostatic load, unhealthy behaviors, and depressive disorder in U.S. adults, 2005-2012 NHANES.
        Prev Med. 2018; 110: 9-15
        • Geronimus AT
        • Hicken M
        • Keene D
        • Bound J
        “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States.
        Am J Public Health. 2006; 96: 826-833
        • Rojas-Martínez R
        • Aguilar-Salinas CA
        • Jiménez-Corona A
        • Gómez-Pérez FJ
        • Barquera S
        • Lazcano-Ponce E
        Prevalence of obesity and metabolic syndrome components in Mexican adults without type 2 diabetes or hypertension.
        Salud Publica Mex. 2012; 54: 7-12
        Date accessed: September 2, 2019
        • Popkin BM
        • Reardon T.
        Obesity and the food system transformation in Latin America.
        Obes Rev. 2018; 19: 1028-1064
        • Popkin BM
        • Slining MM.
        New dynamics in global obesity facing low‐ and middle‐income countries.
        Obes Rev. 2013; 14: 11-20
      1. Public charge fact sheet. U.S. Citizenship and Immigration Services. Updated September 22, 2020. Accessed March 30, 2020.

        • Pierce S
        • Bolter J
        • Selee A
        U.S. immigration policy under Trump: deep changes and lasting impacts.
        Migration Policy Institute, Washington, DCPublished July 2018
        • HHS, Centers for Disease Control and Prevention, National Center for Health Statistics
        National Health and Nutrition Examination Survey, 2007-2008: overview. HHS, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD2007 (Published January 2007)
        • Salazar CR
        • Strizich G
        • Seeman TE
        • et al.
        Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos.
        SSM Popul Health. 2016; 2: 416-424
        • Boyd RW
        • Lindo EG
        • Weeks LD
        • McLemore MR
        On racism: a new standard for publishing on racial health inequities.
        Health Affairs Blog. July 2, 2020;
        • Yudell M
        • Roberts D
        • DeSalle R
        • Tishkoff S
        • 70 signatories
        NIH must confront the use of race in science.
        Science. 2020; 369: 1313-1314
        • Brown TH
        • O'Rand AM
        • Adkins DE
        Race-ethnicity and health trajectories: tests of three hypotheses across multiple groups and health outcomes.
        J Health Soc Behav. 2012; 53: 359-377
        • Warner DF
        • Brown TH.
        Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach.
        Soc Sci Med. 2011; 72: 1236-1248
        • Kim J
        • Miech R.
        The Black-White difference in age trajectories of functional health over the life course.
        Soc Sci Med. 2009; 68: 717-725
        • Flegal KM
        • Carroll MD
        • Kit BK
        • Ogden CL
        Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999-2010.
        JAMA. 2012; 307: 491-497
        • Rivera JA
        • Barquera S
        • Campirano F
        • Campos I
        • Safdie M
        • Tovar V
        Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity.
        Public Health Nutr. 2002; 5: 113-122
        • Passel JS
        • Cohn D
        • Gonzalez-Barrera A
        Net migration from Mexico falls to zero—and perhaps less.
        Pew Research Center, Washington, DCPublished April 23, 2012
        • Villarreal A.
        Explaining the decline in Mexico-U.S. migration: the effect of the Great Recession.
        Demography. 2014; 51: 2203-2228
        • Daviglus ML
        • Talavera GA
        • Avilés-Santa ML
        • et al.
        Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.
        JAMA. 2012; 308: 1775-1784
        • Isasi CR
        • Ayala GX
        • Sotres-Alvarez D
        • et al.
        Is acculturation related to obesity in Hispanic/Latino adults? Results from the Hispanic Community Health Study/Study of Latinos.
        J Obes. 2015; 2015186276
        • Creighton MJ
        • Goldman N
        • Pebley AR
        • Chung CY
        Durational and generational differences in Mexican immigrant obesity: is acculturation the explanation?.
        Soc Sci Med. 2012; 75: 300-310
        • Abraído-Lanza AF
        • Dohrenwend BP
        • Ng-Mak DS
        • Turner JB
        The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses.
        Am J Public Health. 1999; 89: 1543-1548
        • Diaz CJ
        • Koning SM
        • Martinez-Donate AP
        Moving beyond salmon bias: Mexican return migration and health selection.
        Demography. 2016; 53: 2005-2030
        • Bostean G.
        Does selective migration explain the Hispanic paradox? A comparative analysis of Mexicans in the U.S. and Mexico.
        J Immigr Minor Health. 2013; 15: 624-635
        • Lui M
        • Robles B
        • Leondar-Wright B
        • Brewer R
        • Adamson R
        The Color of Wealth: The Story Behind the U.S. Racial Wealth Divide.
        The New Press, New York, NY2006
        • Kochhar R
        • Fry R
        Wealth inequality has widened along racial, ethnic lines since end of Great Recession.
        Pew Research Center, Washington, DCPublished December 12, 2014
        • U.S. Census Bureau
        Figure 1. Real median household income by race and Hispanic origin: 1967 to 2017.
        U.S. Census Bureau, Suitland-Silver Hill, MDPublished 2018
        • Artiga S
        • Orgera K
        • Damico A
        Changes in health coverage by race and ethnicity since the ACA, 2010-2018.
        Kaiser Family Foundation, San Francisco, CAPublished March 5, 2020
        • Fleming PJ
        • Novak NL
        • Lopez WD
        U.S. immigration law enforcement practices and health inequities.
        Am J Prev Med. 2019; 57: 858-861
        • Peek MK
        • Cutchin MP
        • Salinas JJ
        • et al.
        Allostatic load among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin: effects of ethnicity, nativity, and acculturation.
        Am J Public Health. 2010; 100: 940-946
        • Kaestner R
        • Pearson JA
        • Keene D
        • Geronimus AT
        Stress, allostatic load and health of Mexican immigrants.
        Soc Sci Q. 2009; 90: 1089-1111