Unequal Embodiment: Racial and Ethnic Heterogeneity in the Predictors and Age-Related Health Outcomes Associated with Accelerated Biological Aging

BACKGROUND: This study investigates whether life-course socioeconomic exposures are similarly associated with accelerated biological aging across racial and ethnic groups, and whether accelerated biological aging predicts health outcomes equivalently across groups. METHODS: Data came from the Health and Retirement Study (2016-2022). Accelerated biological age was derived from 22 blood-based biomarkers from the 2016 Venous Blood Study. We used linear regression models with interactions between race/ethnicity and life-course exposures (childhood adversity and adult/midlife socioeconomic status (SES)) to assess group differences in accelerated aging. Linear, multinomial, and logistic regression models with interactions between accelerated biological age and race/ethnicity were used to assess group differences in health outcomes. We examined differences by foreign-born status among Hispanic adults. RESULTS: Associations between life-course exposures, accelerated biological aging, and health varied by race/ethnicity. Compared to non-Hispanic White adults, childhood health and adversity were not associated with accelerated biological aging for non-Hispanic Black and Hispanic adults, and among these groups, higher midlife SES did not decelerate biological aging. The association between accelerated biological age and health outcomes varied by race/ethnicity; accelerated biological age was less predictive among non-Hispanic Black and Hispanic adults. Among Hispanic adults, foreign-born status was a significant moderator: increased biological age was more strongly linked to morbidity among foreign-born individuals. CONCLUSIONS: The processes linking life-course conditions to biological aging, and biological aging to later-life health, do not translate uniformly across racial/ethnic groups. Future research should explore the sources of heterogeneity in life-course exposures and the mechanisms by which biological age translates into health outcomes.