Disparities in insulin resistance between black and white adults in the United States: The role of lifespan stress exposure
Open accessAbstract
Background Disparities in insulin resistance between Black and White adults in the United States are well documented, yet relatively little is known about the psychosocial or biological antecedents of these inequities. The current study examined childhood adversity and contemporaneous psychosocial stressors in adulthood as possible mediators of the racial disparity in insulin resistance. Inflammatory and hypothalamic-pituitary adrenal (HPA) axis mechanisms implicated in associations between lifespan stress exposure and insulin resistance were also considered.Methods Data were derived from the biomarker component of the Midlife in the United States Study (N = 1170, 20% Black, 56% female, Mean age = 54.7 years, SD = 11.6). A homeostatic model assessment of insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Twelve risk factors relating to household dysfunction, socioeconomic disadvantage, and maltreatment were sum scored to index childhood adversity. Measures of adult stress included socioeconomic adversity, major stressful events, everyday discrimination, and lifetime discrimination.Results Levels of insulin resistance were higher among Black than White adults. Childhood adversity was positively associated with HOMA-IR, and attenuated 18% of the race difference. Measures of adult stress mediated 33% of the association between childhood adversity and HOMA-IR, and accounted for an additional 47% of the race difference. Higher inflammation and lower nocturnal cortisol both played an important role in mediating the association between stress exposure and HOMA-IR.Conclusions Findings are consistent with prior research showing that childhood adversity and adult stress are salient predictors of glucose metabolism, and extend this work by showing that lifespan stress exposures attenuate a significant portion of the Black-White disparity in HOMA-IR. Results also suggest stress effects on insulin resistance through inflammatory and HPA-axis pathways.
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In a recent analysis of biomarker data from 1170 adults (20% Black, 56% women) enrolled in the Midlife in the United States Study, ACEs and adult psychosocial stress together mediated 65% of the difference in HOMA-IR between Black and White adults in the United States.
“ACEs and adult stress together mediated 65% of the difference in HOMA-IR between Black and White adults in the United States.”
From The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review (2024) · cites this paper as [137]
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References 55 · Cited by 35
- Authors
- Fuller-Rowell, T. E., Homandberg, L. K., Curtis, D. S., Tsenkova, V. K., Williams, D. R., & Ryff, C. D.
- Affiliations
- Auburn University (US)
- University of Utah (US)
- University of Wisconsin–Madison (US)
- Harvard University (US)
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2019-09
- Volume
- 107
- Pages
- 1-8
- ISSN
- 0306-4530 (ISSN-L)
- PMC
- PMC6635018
- OpenAlex
- W2942715531
- Cited by
- 35
- References
- 55
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 7 · 2020: 2
- FWCI
- 3.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- insulin resistance, racial disparities, black-white disparities, childhood adversity, psychosocial stress, hypothalamic-pituitary-adrenal axis, inflammation, cortisol, discrimination, socioeconomic adversity, maltreatment, glucose metabolism, HOMA-IR
- MeSH terms
- Adverse Childhood Experiences, Adult, Black or African American, Female, Humans, Hypothalamo-Hypophyseal System, Inflammation, Insulin, Insulin Resistance, Longevity, Male, Middle Aged, Pituitary-Adrenal System, Risk Factors, Stress, Psychological, United States, Biomarkers, Body Mass Index, White People, Racism
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