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Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index



Disparities in adult morbidity and mortality may be rooted in patterns of biological dysfunction in early life. We sought to examine the association between pathogen burden and a cumulative deficits index (CDI), conceptualized as a pre-clinical marker of an unhealthy biomarker profile, specifically focusing on patterns across levels of social disadvantage.


Using the data from the National Health and Nutrition Examination Survey 2003–2004 wave (aged 20–49 years), we examined the association of pathogen burden, composed of seven pathogens, with the CDI. The CDI comprised 28 biomarkers corresponding to available clinical laboratory measures. Models were stratified by race/ethnicity and education level.


The CDI ranged from 0.04 to 0.78. Nearly half of Blacks were classified in the high burden pathogen class compared with 8% of Whites. Among both Mexican Americans and other Hispanic groups, the largest proportion of individuals were classified in the common pathogens class. Among educational classes, 19% of those with less than a high school education were classified in the high burden class compared with 7% of those with at least a college education. Blacks in the high burden pathogen class had a CDI 0.05 greater than those in the low burden class (P < 0.05). Whites in the high burden class had a CDI only 0.03 greater than those in the low burden class (P < 0.01).


Our findings suggest there are significant social disparities in the distribution of pathogen burden across race/ethnic groups, and the effects of pathogen burden may be more significant for socially disadvantaged individuals.

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G.A. Noppert received support from the National Institute on Aging through Duke University (grant number 5 T32-AG000029-41), the Eunice Kennedy Shriver Institute of Child Health and Human Develpoment through the Unversity of North Carolina at Chapel Hill (grant number T32-HD-091058), and the National Institute on Aging through the University of North Carolina at Chapel Hill (grant number K99AG0627-01A1). A.M.O'Rand received support from the National Institute on Aging through the Duke Center for Population Health and Aging (grant number P30 AG034424).

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Correspondence to Grace A. Noppert.

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Noppert, G.A., Aiello, A.E., O’Rand, A.M. et al. Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index. J. Racial and Ethnic Health Disparities 7, 99–108 (2020).

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  • Pathogen burden
  • Racial disparities
  • Educational disparities
  • Biological aging