Chang Michelle, Robles Theodore F
Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095.
Proc Natl Acad Sci U S A. 2025 Jun 17;122(24):e2313600122. doi: 10.1073/pnas.2313600122. Epub 2025 Jun 10.
Though racial disparities in shortened life expectancy have been well established, racial disparities in the burden of bereavement after such premature deaths are severely understudied. This is, in part, due to a lack of measurement tools for characterizing lifetime exposure to loss. We propose three indices that simultaneously quantify premature and cumulative lifetime loss-two typically unmeasured dimensions of loss. Using a longitudinal US sample of 27,985 participants from the Health and Retirement Study (1992 to 2020) who experienced at least one lifetime loss, hierarchical linear models accounting for participants nested within households showed that Black participants and Native American participants had higher premature and cumulative burden of family member loss over the lifetime than all other racial groups across all three indices. These effects remained for Black participants after controlling for covariates such as parental education, household size, and years in the study. Second, we found that loss burden at study enrollment prospectively related to all-cause mortality. Depending on prematurity, each additional loss related to higher odds of dying during the study period after controlling for covariates such as chronic health conditions. Together, our work leverages prospective, longitudinal methodologies to identify racial disparities in exposure to earlier and repeated death and its impact on mortality among the bereaved. The proposed measurement approach has future applications for understanding how loss exposure-both "too soon" and "too much"-predicts poor health and earlier mortality.
尽管预期寿命缩短方面的种族差异已得到充分证实，但此类过早死亡后丧亲负担方面的种族差异却严重缺乏研究。部分原因在于缺乏用于描述一生经历损失情况的测量工具。我们提出了三个指数，它们能同时量化过早和累积的终身损失——这是损失的两个通常未被测量的维度。利用来自健康与退休研究（1992年至2020年）的27985名美国参与者的纵向样本，这些参与者至少经历过一次终身损失，考虑到参与者嵌套在家庭中的分层线性模型显示，在所有三个指数方面，黑人参与者和美国原住民参与者一生中家庭成员损失的过早和累积负担高于所有其他种族群体。在控制了诸如父母教育程度、家庭规模和参与研究的年限等协变量后，黑人参与者的这些影响依然存在。其次，我们发现研究入组时的损失负担与全因死亡率存在前瞻性关联。根据早产情况，在控制了诸如慢性健康状况等协变量后，每增加一次损失与研究期间死亡几率的增加相关。我们的工作共同利用前瞻性纵向方法，来识别过早和反复死亡暴露方面的种族差异及其对丧亲者死亡率的影响。所提出的测量方法在未来可用于理解“过早”和“过多”的损失暴露如何预测健康状况不佳和过早死亡。
