Understanding intersectional inequalities in physiological wear-and-tear and mortality: Multi-level analyses of the UK Household Longitudinal Study (Understanding Society)

Research that uses an intersectional framing examines how social, economic and demographic categories (such as ethnicity, social class and gender) interconnect and interact to create modes of discrimination and privilege. In health research, those intersections can be manifested in worse health outcomes in certain groups within our populations. In turn, intersectional inequalities have been linked to exacerbated health inequalities, where systems of disadvantage mutually reinforce each other through interaction to create unique experiences of intersecting identities. The aim of our research was to build on emerging work examining quantitative assessments of intersectionality and pre-disease physiological markers to incorporate physiological wear-and-tear, as measured by allostatic load, as the outcome of interest. We will present results from longitudinal analysis of the UK Household Longitudinal Study (UKHLS/Understanding Society) where we have modelled the relationships between intersectional circumstances, allostatic load, and 5 and 10-year mortality, using multi-level modelling approaches (MAIHDA). In summary, we found that being male, older, with lower socioeconomic position (occupation and education) or having a limiting longstanding illness were consistently associated with worth allostatic load and mortality risk. Ethnicity showed more mixed results. We also identified that while intersectional inequalities exist, these were largely additive in nature, rather than multiplicative and these patterns were consistent with both allostatic load and mortality outcomes. We will discuss these findings in the context of putting intersectionality theory into (quantitative) practice, especially in studies of health inequalities.