Residential segregation, everyday unfair treatment, and allostatic load: Examining cross-level interactions

Background: A growing literature has investigated the causal pathways linking social determinants and disease. Increasingly examined is the role of stress and the physiologic damage caused to the body due to chronic stress, through multiple biologic pathways that may accumulate across the lifespan. Stressful experiences trigger hormone release that is damaging to the body, particularly when stress is chronic. Discrimination and segregation – conceptualized as chronic stressors – have been linked to allostatic load. One area in need of further exploration is determining the conditions under which individuals are most vulnerable to the effects of chronic stress; thus, this study examines the joint effects of individual and neighborhood level stress on allostatic load. Methods: For this analysis, we used the 2002 Detroit Healthy Environments Partnership's two-stage random probability survey of 919 adults and the 2000 Census data for the corresponding 69 block groups. We tested the hypothesis that neighborhood characteristics (i.e., percent poverty and residential segregation) are associated with allostatic load, controlling for individual and neighborhood level covariates. We also tested whether these associations were mediated or moderated by everyday unfair treatment. Relationships were estimated using hierarchical linear modeling. Preliminary Findings: Preliminary findings show that neighborhood characteristics are associated with allostatic load in fully adjusted models. Unfair treatment does not mediate these relationships, but does modify the relationship between poverty and allostatic load. Discussion: The interaction between poverty and segregation may indicate that individuals in our sample experience higher levels of stress due to class-based (as opposed to race-based) discrimination.