Community-level age bias and older adult mortality

Abstract

Rationale: As the older adult population increases, understanding the health effects of bias against older adults is increasingly important. Whether structural forms of age bias predict worse health has received limited attention.

Objective: We hypothesized that communities with greater age bias would have higher mortality among residents aged 65 and older. We expected the association to be unique to age bias, rather than general bias (i.e., sexual minority and racial bias), and that the age bias-mortality association would be strongest in predominantly White and younger communities.

Methods: Explicit and implicit attitudes toward older adults (N = 1,001,735), sexual minorities (N = 791,966), and Black Americans (N = 2,255,808) were drawn from Project Implicit. Post-stratification relative to U.S. Census demographics was executed to improve the representativeness of county-level explicit and implicit bias estimates. County older adult mortality, estimated cross-sectionally with and longitudinally relative to bias scores, served as outcomes. Models controlled for relevant county-level covariates (e.g., median age) and included all U.S. counties (N = 3142).

Results: Contrary to hypotheses but consistent with prior work, explicit age bias was cross-sectionally and longitudinally associated with lower mortality, over and above covariates and generalized community bias. The explicit age bias-lower mortality association only emerged in younger counties but did not depend on county ethnic composition. Implicit age bias was unassociated with outcomes. Post-hoc analyses supported that ageist communities may be associated with better health across the lifespan. Explicit age bias predicted lower mortality in young and middle adulthood; better mental health in middle adulthood, but not exercise or self-rated health, mediated the explicit age bias-older adult mortality association.

Conclusions: Results highlight the uniqueness of older age relative to other stigmatized identities. Further examination of the association of community-level age bias with better health may improve longevity for all communities.

Keywords: Ageism; Explicit bias; Implicit bias; Mortality risk; Structural stigma.

Figure 1

Maps of County-level Explicit and Implicit Age Bias and Longitudianl (2019) Mortality Rate