# Measuring premature and cumulative family member bereavement: Racial disparities and later mortality risk

## TL;DR

This study shows that Black and Native American people experience more premature and repeated family deaths, which increases their risk of dying later, highlighting the impact of structural racism.

## Contribution

The paper introduces three new measures to quantify premature and cumulative family member bereavement and links them to mortality disparities.

## Key findings

- Black and Native American participants experienced more premature and cumulative family deaths compared to other racial groups.
- Higher bereavement burden at study enrollment was associated with increased odds of mortality during the study period.
- The proposed measures can help understand how exposure to loss predicts poor health and earlier death.

## Abstract

Structural racism has created longstanding conditions for certain racially oppressed groups to die prematurely. While premature death is studied as an end point, considerably less work studies it as a “beginning point” for surviving bereaved communities. Exposure to earlier and repeated deaths is an important lens for characterizing suffering in people of color, and we create three measures of such loss exposure. Results showed that Black and Native American participants lost family members “too soon” and “too much” compared to all other participants. Moreover, those with higher loss burden had higher odds of dying during the study. Given crises of COVID and police brutality, this study urges attending to racial disparities in bereavement and mortality as products of structural racism.

Though racial disparities in shortened life expectancy have been well established, racial disparities in the burden of bereavement after such premature deaths are severely understudied. This is, in part, due to a lack of measurement tools for characterizing lifetime exposure to loss. We propose three indices that simultaneously quantify premature and cumulative lifetime loss—two typically unmeasured dimensions of loss. Using a longitudinal US sample of 27,985 participants from the Health and Retirement Study (1992 to 2020) who experienced at least one lifetime loss, hierarchical linear models accounting for participants nested within households showed that Black participants and Native American participants had higher premature and cumulative burden of family member loss over the lifetime than all other racial groups across all three indices. These effects remained for Black participants after controlling for covariates such as parental education, household size, and years in the study. Second, we found that loss burden at study enrollment prospectively related to all-cause mortality. Depending on prematurity, each additional loss related to higher odds of dying during the study period after controlling for covariates such as chronic health conditions. Together, our work leverages prospective, longitudinal methodologies to identify racial disparities in exposure to earlier and repeated death and its impact on mortality among the bereaved. The proposed measurement approach has future applications for understanding how loss exposure—both “too soon” and “too much”—predicts poor health and earlier mortality.