Abstract
This study examines race and sex differences in the latent structure of 10 psychosocial measures and the association of identified factors with self-reported history of coronary heart disease (CHD). Participants were 4,128 older adults from the Chicago Health and Aging Project. Exploratory factor analysis (EFA) with oblique geomin rotation was used to identify latent factors among the psychosocial measures. Multi-group comparisons of the EFA model were conducted using exploratory structural equation modeling to test for measurement invariance across race and sex subgroups. A factor-based scale score was created for invariant factor(s). Logistic regression was used to test the relationship between the factor score(s) and CHD adjusting for relevant confounders. Effect modification of the relationship by race–sex subgroup was tested. A two-factor model fit the data well (comparative fit index = 0.986; Tucker–Lewis index = 0.969; root mean square error of approximation = 0.039). Depressive symptoms, neuroticism, perceived stress, and low life satisfaction loaded on Factor I. Social engagement, spirituality, social networks, and extraversion loaded on Factor II. Only Factor I, re-named distress, showed measurement invariance across subgroups. Distress was associated with a 37% increased odds of self-reported CHD (odds ratio: 1.37; 95% confidence intervals: 1.25, 1.50; p-value < 0.0001). This effect did not differ by race or sex (interaction p-value = 0.43). This study identified two underlying latent constructs among a large range of psychosocial variables; only one, distress, was validly measured across race–sex subgroups. This construct was robustly related to prevalent CHD, highlighting the potential importance of latent constructs as predictors of cardiovascular disease.
Highlights
Research into the influence of psychosocial risk factors on health has exploded over the past few decades
The sample was comprised of 38% black females (n = 1555), 24% white females (n = 995), 24% black males (n = 908), and 14% white males (n = 598)
In the Exploratory factor analysis (EFA), a three factor solution was a better fit than a twoor one-factor model based on having the highest comparative fit index (CFI) and Tucker–Lewis index (TLI) and the lowest root mean square error of approximation (RMSEA) (Table 2)
Summary
Research into the influence of psychosocial risk factors on health has exploded over the past few decades. This approach ignores interrelationships among psychosocial factors and potentially leads to inconsistent results (Suls and Bunde, 2005) This practice prevails despite the fact that many psychosocial factors are correlated to some degree with one another (Raynor et al, 2002; Kudielka et al, 2004; Suls and Bunde, 2005; Konttinen et al, 2008), involve considerable construct and measurement overlap (Suls and Bunde, 2005), relate to poor health (Konttinen et al, 2008), and tend to cluster together in individuals (Kaplan, 1995; Williams et al, 1997b; Rozanski et al, 1999, 2005; Orth-Gomer et al, 2005). It may be a commonality among these variables rather than a distinct feature of each variable that is associated with CVD risk (Boyle et al, 2006)
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