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J Gerontol B Psychol Sci Soc Sci. 2018 Mar 2;73(3):468-476. doi: 10.1093/geronb/gbw080.

Socioeconomic Status, Race/Ethnicity, and Diurnal Cortisol Trajectories in Middle-Aged and Older Adults.

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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland.
Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland.
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center on Aging and Health, Baltimore, Maryland.
Department of Environmental Health Sciences.
Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Johns Hopkins University Center for Health Disparities Solutions, Baltimore, Maryland.



Slow afternoon cortisol decline may be a marker of aging. We hypothesize that lower socioeconomic status (SES) and African American race are associated with lower waking cortisol and slower afternoon decline.


Six salivary cortisol samples, collected within a 24-hr period from 566 cohort participants aged 56-78 years, were examined in random-effects models. SES measures included socioeconomic vulnerability (household income and assets <500% of poverty) and education (≥college, some college, and ≤high school). African Americans were compared with all others.


Adjusting for age and sex, intermediate, but not low, education was associated with approximately 17% lower average waking cortisol and 1% slower decline, compared with high education. Socioeconomic vulnerability was not associated with waking cortisol or linear decline. Accounting for African American race/ethnicity, socioeconomic vulnerability was associated with a 3% faster decline, and education was not associated with cortisol. African Americans had 26% lower average waking cortisol and 1% slower decline than others.


African American race/ethnicity, but not lower SES, was associated with lower waking cortisol and slower afternoon decline in middle-aged and older adults. This pattern is likely a marker of earlier biological aging in vulnerable groups. Race/ethnicity may compete with SES as a measure of cumulative vulnerability.

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