The weathering hypothesis as an explanation for racial disparities in health: a systematic review

Purpose: The weathering hypothesis states that chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes and could partially explain racial disparities in a wide array of health conditions. This systematic review summarizes the literature empirically testing the weathering hypothesis and assesses the quality of the evidence regarding weathering as a determinant of racial disparities in health. Methods: Databases (Web of Science, Ovid MEDLINE, PubMed, and Embase) were searched for studies published in English up to July 1, 2017. Studies that tested the weathering hypothesis for any physical health outcome and included at least one socially or economically disadvantaged group (e.g., Blacks) for whom the weathering hypothesis applies were assessed for eligibility. Threats to validity were assessed using the Quality in Prognostic Studies tool. Results: The 41 included studies were rated as having overall good methodological quality. Most studies found evidence in support of the weathering hypothesis, although the magnitude of support varied by the health outcome and population studied. Conclusions: Future evaluations of the weathering hypothesis should include an examination of additional health outcomes and interrogate mechanisms that could link weathering to poor health.