Discussion
Our data suggest that there is substantial heterogeneity in the effect of the stressors studied here on high perceived stress (PS) by ethnicity and age. Our results suggest that the overall trend indicates PS diminishes with age for most putative stressors, but that there are substantial age- and ethnicity-specific differences in these patterns. In general, the factors studied here were more strongly associated with PS in White men, and least associated with PS in Hispanic men. These results suggest that interventions that attempt to mediate stress or that study these stressors as disease risk factors should be aware the age and ethnicity modulate some (but not all) of these relationships.
We have made a number of assumptions in the model choices we have made that could have influenced our results. We undertook logistic models using a common reference group to evaluate the association with PS of each level of stressor by age and ethnicity. The relationships among these variables are likely to be complex, and the assumption of log-linearity applied here may not be appropriate. While this study was a population-based survey, there is the potential that the sampling design or the low response rate led to biases in our analyses. While our overall sample was relatively large, the subgroup of Hispanic men was substantially smaller and it is possible we were not able to detect interactions involving Hispanic men due to sample size limitations. In addition, the response rate in some groups was low (e.g., < 50% of all eligible respondents). Therefore, the generalizability of the results may be limited, and not represent the general populations from which this sample was drawn. Despite the large size of some groups, some odds ratio estimates were generated from smaller sample strata, which resulted in large confidence intervals and less stable inferences. For these groups, caution should be used when interpreting the data. Finally, we adjusted for stressors that reflect overall health status, education, and household poverty to correct for differences among strata that may lead to confounding. However, other confounders may be acting that were not measured in this study, and therefore we cannot rule out the potential that some residual confounding remains in this analysis.
Despite these limitations, there is a large literature that supports the hypothesis that stressors have an important impact on health status, and therefore differences in the relationship of these factors by age or ethnicity could (in part) explain some health disparities. It is clear from both animal and human studies that exposure to chronic stress and an individual's behavioral or physiological response to those stressors is relevant to their health. In men, exposure to stressors has a variety of biological effects that have an influence on health, including vulnerability to brain-dependent and stress-related mental and physical health conditions, susceptibility to frailty in aging adults, reproductive impairment, obesity and metabolic syndrome, cardiovascular stress reactivity, and a variety of biomarkers of endocrine dysfunction, inflammation or allostatic load that are correlated with altered health and cognition. In addition, therapeutic interventions or altering social interactions to reduce or manage stress are available. However, the literature in these domains has generally not explored the potential that these relationships differ significantly by age or ethnicity. Our results suggest that the stressors studied here are more likely to be associated with PS in White men compared with Hispanic men. This may mean that the stressors measured here are more relevant to White men and other factors may be more relevant to Hispanic men. However, if our data are confirmed and extended to other phenotypes, the information provided here may assist in developing tailored studies or strategies for the reduction of stress-related health disparities.