Race and Ethnicity Moderates the Relationship between Family Income Level and Allostatic Load among Adolescents in the United States

Purpose: People from low-income households are at risk of high allostatic load (AL) in adulthood, which is linked to poor physical and mental health outcomes. It is unclear how early the income-AL link develops and whether this association differs by race and/or ethnicity. We examined associations of family income with high AL among adolescents and whether race and/or ethnicity modified associations.Methods: Cross-sectional, nationally representative data came from 748 US adolescents (aged 12-17 years) who participated in the pre-pandemic 2017–March 2020 National Health and Nutrition Examination Survey. Family income was measured using poverty-income ratio (PIR) and categorized as low-income (PIR < 1.0), middle-income (PIR 1.0–4.0), and high-income (PIR > 4.0). AL was derived from nine biomarkers. Modified Poisson regression models estimated prevalence ratios (PRs) for associations of family income with high AL overall and stratified by race and/or ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic).Results: Nearly 1 in 5 adolescents (19.7%) met criteria for high AL. Compared to high-income peers, middle-income adolescents had more than twice the prevalence of high AL (PR: 2.16; 95% CI: 1.13, 4.13), and low-income adolescents had nearly triple the prevalence of high AL (PR: 2.98; 95% CI: 1.76, 5.04). Stratified models observed these associations only for non-Hispanic White adolescents, while for non-Hispanic Black and Hispanic youth, associations were attenuated and nonsignificant.Discussion: Higher family income was protective against high AL only for non-Hispanic White adolescents. Minority youth may face additional stressors that diminish the protective effects of higher income.