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.
AneshenselCarol S.2005. “Research in Mental Health: Social Etiology Versus Social Consequences.” Journal of Health and Social Behavior46(3):221–28.
2.
Ben-ShlomoYoavKuhDiana. 2002. “A Life Course Approach to Chronic Disease Epidemiology: Conceptual Models, Empirical Challenges, and Interdisciplinary Perspectives.” International Journal of Epidemiology31(2):285–93.
3.
Bibbins-DomingoKirstenPletcherMark J.LinFengVittinghoffEricGardinJulius M.ArynchynAlexanderLewisCora E.WilliamsO. DaleHulleyStephen B.2009. “Racial Differences in Incident Heart Failure among Young Adults.” New England Journal of Medicine360(12):1179–90.
4.
BoenCourtney. 2020. “Death by a Thousand Cuts: Stress Exposure and Black–White Disparities in Physiological Functioning in Late Life.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences75(9):1937–50.
5.
BorJacobVenkataramaniAtheendar S.WilliamsDavid R.TsaiAlexander C.2018. “Police Killings and Their Spillover Effects on the Mental Health of Black Americans: A Population-Based, Quasi-experimental Study.” The Lancet392(10144):302–10.
6.
BravemanPaulaBarclayColleen. 2009. “Health Disparities Beginning in Childhood: A Life Course Perspective.” Pediatrics124(Suppl.):S163–75.
7.
BrownLauren L.MitchellUchechi A.AilshireJennifer A.2020. “Disentangling the Stress Process: Race-Ethnic Differences in the Exposure and Appraisal of Chronic Stressors among Older Adults.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences75(3):650–60.
8.
BrownTyson H.2018. “Racial Stratification, Immigration, and Health Inequality: A Life Course-Intersectional Approach.” Social Forces96(4):1507–40.
9.
BuckleyThomasMcKinleySharonToflerGeoffreyBartropRoger. 2010. “Cardiovascular Risk in Early Bereavement: A Literature Review and Proposed Mechanisms.” International Journal of Nursing Studies47(2):229–38.
10.
ChaHyungminThomasPatricia A.UmbersonDebra. 2021. “Sibling Deaths, Racial-Ethnic Disadvantage, and Dementia in Later Life.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. doi:10.1093/geronb/gbab202.
11.
ChengYiling J.KanayaAlka M.AranetaMaria Rosario G.SaydahSharon H.KahnHenry S.GreggEdward W.FujimotoWilfred Y.ImperatoreGiuseppina. 2019. “Prevalence of Diabetes by Race and Ethnicity in the United States, 2011–2016.” Journal of the American Medical Association322(24):2389–98.
12.
CooperLisa A.WilliamsDavid R.2020. “Excess Deaths from COVID-19, Community Bereavement, and Restorative Justice for Communities of Color.” JAMA324(15):1491–92.
13.
DonnellyRachelUmbersonDebraHummerRobert A.GarciaMichael A.2020. “Race, Death of a Child, and Mortality Risk among Aging Parents in the United States.” Social Science & Medicine249:112853. doi:10.1016/j.socscimed.2020.112853.
14.
DonnellyRachelUmbersonDebraPudrovskaTetyana. 2020. “Family Member Death, and Subjective Life Expectancy among Black and White Older Adults.” Journal of Aging and Health32(3–4):143–53.
15.
DupreMatthew E.BeckAudrey N.MeadowsSarah O.2009. “Marital Trajectories and Mortality among U.S. Adults.” American Journal of Epidemiology170(5):546–55.
16.
FerraroKenneth F.ShippeeTetyana P.2009. “Aging and Cumulative Inequality: How Does Inequality Get under the Skin?” The Gerontologist49(3):333–43.
17.
FerraroKenneth F.WilmothJanet M.2000. “Measuring Morbidity: Disease Counts, Binary Variables, and Statistical Power.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences55(3):S173–89.
18.
GarciaMarc A.HomanPatricia A.GarciaCatherineBrownTyson H.2021. “The Color of COVID-19: Structural Racism and the Disproportionate Impact of the Pandemic on Older Black and Latinx Adults.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences76(3):75–80.
19.
GeeGilbert C.WalsemannKatrina M.BrondoloElizabeth. 2012. “A Life Course Perspective on How Racism May Be Related to Health Inequities.” American Journal of Public Health102(5):967–74.
20.
GeronimusArline T.HickenMargaretKeeneDanyaBoundJohn. 2006. “‘Weathering’ and Age Patterns of Allostatic Load Scores among Blacks and Whites in the United States.” American Journal of Public Health96(5):826–33.
21.
GoosbyBridget J.CheadleJacob E.MitchellColter. 2018. “Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities.” Annual Review of Sociology44:319–40.
22.
HatchStephani L.2005. “Conceptualizing and Identifying Cumulative Adversity and Protective Resources: Implications for Understanding Health Inequalities.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences60(2):130–34.
23.
HeeringaSteven G.WestBrady T.BerglundPatricia A.2017. Applied Survey Data Analysis. 2nd ed.Boca Raton, FL: Chapman and Hall/CRC.
24.
HendricksonKarrie C.2009. “Morbidity, Mortality, and Parental Grief: A Review of the Literature on the Relationship between the Death of a Child and the Subsequent Health of Parents.” Palliative & Supportive Care7(1):109–19.
25.
JulianneHolt-LunstadSmithTimothy B.LaytonJ. Bradley. 2010. “Social Relationships and Mortality Risk: A Meta-analytic Review.” PLoS Medicine7(7):e1000316. doi:10.1371/journal.pmed.1000316.
26.
JacobsJohn R.BovassoGregory B.2009. “Re-examining the Long-Term Effects of Experiencing Parental Death in Childhood on Adult Psycho-pathology.” The Journal of Nervous and Mental Disease197(1):24–27.
27.
KidmanRachelMargolisRachelSmith-GreenawayEmilyVerderyAshton M.2021. “Estimates and Projections of COVID-19 and Parental Death in the U.S.” JAMA Pediatrics175(7):745–46.
28.
KochanekKenneth D.XuJiaquanAriasElizabeth. 2020. Mortality in the United States, 2019. National Center for Health Statistics Data Brief, No. 395. Hyattsville, MD: National Center for Health Statistics.
29.
KuhDianaBen-ShlomoYoavLynchJohnHallqvistJohanPowerChris. 2003. “Life Course Epidemiology.” Journal of Epidemiology and Community Health57(10):778–83.
30.
LewisTené T.Van DykeMiriam E.MatthewsKaren A.Barinas-MitchellEmma. 2021. “Race-Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women.” American Journal of Epidemiology190(4):576–87.
31.
LiuHuiLinZhiyongUmbersonDebra. 2022. “Parental Death and Cognitive Impairment: An Examination by Gender and Race-Ethnicity.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences77(6):1164–76.
32.
LiuHuiUmbersonDebraXuMinle. 2020. “Widowhood and Mortality: Gender, Race-Ethnicity, and the Role of Economic Resources.” Annals of Epidemiology45:69–75.
33.
LinI-FenBrownSusan L.WrightMatthew R.HammersmithAnna M.2019. “Depressive Symptoms Following Later-Life Marital Dissolution and Subsequent Repartnering.” Journal of Health and Social Behavior60(2):153–68.
34.
MaierE. HaileyLachmanMargie E.2000. “Consequences of Early Parental Loss and Separation for Health and Well-Being in Midlife.” International Journal of Behavioral Development24(2):183–89.
35.
MezukBrianaAbdouCleopatra M.HudsonDarrellKershawKiarri N.RaffertyJane A.LeeHedwigJacksonJames S.2013. “‘White Box” Epidemiology and the Social Neuroscience of Health Behaviors: The Environmental Affordances Model.” Society and Mental Health3(2):79–95.
36.
MillerGregory E.ChenEdithParkerKaren J.2011. “Psychological Stress in Childhood and Susceptibility to the Chronic Diseases of Aging: Moving toward a Model of Behavioral and Biological Mechanisms.” Psychological Bulletin137(6):959–97.
37.
MitchellColterMcLanahanSaraSchneperLisaGarfinkelIrvBrooks-GunnJeanneNottermanDaniel. 2017. “Father Loss and Child Telomere Length.” Pediatrics140(2):e20163245. doi:10.1542/peds.2016-3245.
38.
MitchellUchechi A.AilshireJennifer A.KimJung KiCrimminsEileen. 2019. “Black–White Differences in 20-Year Trends in Cardiovascular Risk in the United States, 1990–2010.” Ethnicity & Disease29(4):587–98.
39.
National Center for Health Statistics. 2021. Health, United States, 2019. Hyattsville, MD: National Center for Health Statistics.
40.
NortonMaria C.ØstbyeTrulsSmithKen R.MungerRonald G.TschanzJoann T.2009. “Early Parental Death and Late-Life Dementia Risk: Findings from the Cache County Study.” Age and Ageing38(3):340–43.
41.
O’RandAngela M.2006. “Stratification and the Life Course: Life Course Capital, Life Course Risks, and Social Inequality” Pp. 146–62 in Handbook of Aging and the Social Sciences, edited by BinstockR. H.GeorgeL. K.Burlington, VT: Academic Press.
42.
O’RandAngela M.Hamil-LukerJenifer. 2005. “Processes of Cumulative Adversity: Childhood Disadvantage and Increased Risk of Heart Attack across the Life Course.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences60(S2):S117–24.
43.
PattersonSarah E.VerderyAshton M.DawJonathan. 2020. “Linked Lives and Childhood Experience of Family Death on Educational Attainment.” Socius6. doi:10.1177/2378023120975594.
44.
PearlinLeonard I.SchiemanScottFazioElena M.MeersmanStephen C.2005. “Stress, Health, and the Life Course: Some Conceptual Perspectives.” Journal of Health and Social Behavior46(2):205–19.
45.
PearlinLeonard I.SkaffMarilyn McKean. 1996. “Stress and the Life Course: A Paradigmatic Alliance.” The Gerontologist36 (2):239–47.
RogersCatherine H.FloydFrank J.SeltzerMarsha MalickGreenbergJanHongJinkuk. 2008. “Long-Term Effects of the Death of a Child on Parents’ Adjustment in Midlife.” Journal of Family Psychology22(2):203–11.
48.
RogersRichard G.HummerRobert A.KruegerPatrick M.VinneauJustin M.2019. “Adult Mortality” Pp. 355–81 in Handbook of Population, edited by PostonD.Jr. New York, NY: Springer.
49.
RostilaMikaelSaarelaJanKawachiIchiro. 2012. “The Forgotten Griever: A Nationwide Follow-Up Study of Mortality Subsequent to the Death of a Sibling.” American Journal of Epidemiology176(4):338–46.
50.
ShonkoffJack P.GarnerAndrew S.SiegelBenjamin S.DobbinsMary I.EarlsMarian F.McGuinnLauraPascoeJohnWoodDavid L.2012. “The Lifelong Effects of Early Childhood Adversity and Toxic Stress.” Pediatrics129(1):232–46.
51.
ShorEranRoelfsDavid J.BugyiPaulSchwartzJoseph E.2012. “Meta-analysis of Marital Dissolution and Mortality: Re-evaluating the Intersection of Gender and Age.” Social Science & Medicine75(1):46–59.
52.
ShueyKim M.WillsonAndrea E.2008. “Cumulative Disadvantage and Black–White Disparities in Life Course Health Trajectories.” Research on Aging30(2):200–25.
53.
SkinnerKatherine M.MillerDonald R.LincolnElizabethLeeAustinKazisLewis E.2005. “Concordance between Respondent Self-Reports and Medical Records for Chronic Conditions: Experience from the Veterans Health Study.” Journal of Ambulatory Care Management28(2):102–10.
54.
SmithKen R.HansonHeidi A.2015. “Early Life Influences on Health and Mortality” Pp. 752–58 in International Encyclopedia of Social and Behavioral Sciences, edited by WrightJ. D.Amsterdam: Elsevier Ltd.
55.
SmithKen R.HansonHeidi A.NortonMaria C.HollinghausMichael S.MineauGeraldine P.2014. “Survival of Offspring Who Experience Early Parental Death: Early Life Conditions and Later-Life Mortality.” Social Science & Medicine119:180–90.
56.
SonnegaAmandaFaulJessica D.OfstedalMary BethLangaKenneth M.PhillipsJohn W. R.WeirDavid R.2014. “Cohort Profile: The Health and Retirement Study (HRS).” International Journal of Epidemiology43(2):576–85.
57.
SternthalMichelle J.SlopenNatalieWilliamsDavid R.2011. “Racial Disparities in Health: How Much Does Stress Really Matter?” Du Bois Review8(1):95–113.
58.
StroebeMargaretSchutHenkStroebeWolfgang. 2007. “Health Outcomes of Bereavement.” The Lancet370(9603):1960–73.
59.
TaylorRobert J.ChattersLinda M.JacksonJames S.2007. “Religious and Spiritual Involvement among Older African Americans, Caribbean Blacks, and Non-Hispanic Whites: Findings from the National Survey of American Life.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences62(4):S238–50.
60.
ThomeerMieke BethMoodyMyles D.YahirunJenjira. 2022. “Racial and Ethnic Disparities in Mental Health and Mental Health Care During the COVID-19 Pandemic.” Journal of Racial and Ethnic Health Disparities. doi:10.1007/s40615-022-01284-9.
61.
TurnerR. JayLloydDonald A.1995. “Lifetime Traumas and Mental Health: The Significance of Cumulative Adversity.” Journal of Health and Social Behavior36(4):360–76.
62.
UmbersonDebra. 2017. “Black Deaths Matter: Race, Relationship Loss, and Effects on Survivors.” Journal of Health and Social Behavior58(4):405–20.
63.
UmbersonDebraCrosnoeRobertReczekCorinne. 2010. “Social Relationships and Health Behavior across the Life Course.” Annual Review of Sociology36:139–57.
64.
UmbersonDebraDonnellyRachel. 2021. “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: Psychological Sciences and Social Sciences. doi:10.1093/geronb/gbab206.
65.
UmbersonDebraDonnellyRachelXuMinleFarinaMateo P.GarciaMichael A.2020. “Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences75(9):1983–95.
66.
UmbersonDebraOlsonJulie S.CrosnoeRobertLiuHuiPudrovskaTetyanaDonnellyRachel. 2017. “Death of Family Members as an Overlooked Source of Racial Disadvantage in the United States.” Proceedings of the National Academy of Sciences of the United States of America114(5):915–20.
67.
UmbersonDebraWilliamsKristiThomasPatricia A.LiuHuiThomeerMieke B.2014. “Race, Gender, and Chains of Disadvantage: Childhood Adversity, Social Relationships, and Health.” Journal of Health and Social Behavior55(1):20–38.
68.
ViraniSalim S.AlonsoAlvaroBenjaminEmelia J.BittencourtMarcio S.CallawayClifton W.CarsonApril P.ChamberlainAlanna M., et al. 2020. “Heart Disease and Stroke Statistics—2020 Update: A Report from the American Heart Association.” Circulation141(9):e139–596.
69.
WilliamsDavid R.LawrenceJourdyn A.DavisBrigette A.2019. “Racism and Health: Evidence and Needed Research.” Annual Review of Public Health40:105–25.
70.
WilliamsDavid R.MohammedSelina A.LeavellJacintaCollinsChiquita. 2010. “Race, Socioeconomic Status, and Health: Complexities, Ongoing Challenges, and Research Opportunities.” Annals of the New York Academy of Sciences1186:69–101.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
