Stress accounts for more deaths in the United States each year than Alzheimer’s disease or diabetes, according to data from the American Psychological Association.

“They also conclude that stress is epidemic in the U.S. and other Western [countries], and that most of our stressors are social,” said Carol A. Shively, PhD, Professor of Pathology/Comparative Medicine, Wake Forest School of Medicine.

Dr. Shively was one of two experts in social determinants of health featured in the mini-symposium Influence of Social Inequalities and Social Stress on Metabolic Health at the 81st Scientific Sessions. The session, which was originally presented Friday, June 25, can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.

Mika Kivimäki, PhD, FMedSci, Professor of Social Epidemiology, University College London, United Kingdom, presented evidence of the correlation between socioeconomic status (SES) and health. He shared data from the Global Burden of Disease study showing that, from 2000 to 2019, healthy life expectancy increased by two years in high-income countries and by nine years in low-income countries.

“The maturity of this increase is actually attributable to improvements in SES, such as increased GDP (gross domestic product), and improvements in education and reductions in early motherhood,” Dr. Kivimäki said.

Socioeconomic adversity contributes to exposure to risk factors for adverse health outcomes starting in childhood and throughout adulthood, but with no disease specificity, he said.

“Low SES is related to cascades of diseases, including mental and behavioral disorders, which seem to set in motion the development of various physical illnesses which then cluster in these same people and result in multimorbidity,” said Dr. Kivimäki, leader of the Whitehall II study, an ongoing epidemiological cohort study of more than 10,000 British participants, and the principal investigator of the IPD-Work (individual-participant data meta-analysis in working populations) consortium of 17 European cohort studies.

The mechanisms for the underlying association between SES and overall health include exposure to harmful environmental factors, barriers to quality health services, unhealthy lifestyle factors, and chronic stress, among others, he said.

“It’s hard to reduce the stresses in our life. They are stressful because they are uncontrollable,” Dr. Shively said. “However, if you experience a stress and recover well from it physiologically, then you avoid the kind of damage we associate with dilatory stress effects on health.”

Dr. Shively discussed how social stress and diet can affect metabolic health based on evidence from nonhuman primate (NHP) studies. Her pioneering research demonstrated that the deposition of central fat exacerbates coronary and carotid atherosclerosis in NHPs, and that psychosocial stress can cause visceral fat deposition and subsequent atherosclerosis in NHPs.

Diet has a significant influence on stress management, she noted.

“Western diet results in overeating, obesity, and metabolic perturbations—as it does in humans—and exaggerates physiological responses to stress,” she said. “Whereas, by comparison, the Mediterranean diet did not.”

Dr. Shively’s research also shows that social subordination stress—resulting from the social hierarchy of NHP groups—on a Western diet background impairs glucose handling and increases metabolic syndrome and type 2 diabetes.