Allostatic load as a predictor of all-cause and cause-specific mortality in the general population: Evidence from the Scottish Health Survey

Robertson, Tony; Beveridge, G.W.; Bromley, Catherine

doi:10.1371/journal.pone.0183297

Cited by 77 publications

(78 citation statements)

References 32 publications

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“…A study by Borell et al 35 found that after adjustment for sociodemographic variables, mortality rates were 88% higher for participants with the highest AL score. Furthermore, an analysis of a Scottish population reported a higher AL was not associated with any of the specific causes of death over the follow-up period, including cancer death 36 .…”

Section: Discussionmentioning

confidence: 96%

Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

Acheampong

Jiang

Ziogas

et al. 2020

Sci Rep

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Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. this study examined the association of an MSBR index with cancer mortality. the sample included n = 13,628 adults aged 20-90 from the NHANES III Linked Mortality File (1988)(1989)(1990)(1991)(1992)(1993)(1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HoMA ir , triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13-2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07-1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05-1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92-1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.Multi-systemic biological risk (MSBR) is a proxy for allostatic load (AL). It is a metric of health risk that captures the complex biological cascade that occurs in autonomic, metabolic, and immune domains in response to chronic environmental and psychosocial stress 1-3 . The validity of the AL construct is established and demonstrates common variance and statistical coherence between, prominent primary mediators of the stress response (i.e., stress hormones), and secondary mediators reflecting the resulting biological alterations in autonomic, metabolic, and immune domains that accumulate over time [4][5][6][7][8] . Importantly, summary AL indices have demonstrated a non-additive, stronger magnitude of association with outcomes compared with the individual components of the index 9 .Previous research has shown that autonomic, metabolic, and immune disorders, share common risk factors with cancer outcomes 10-12 . Moreover, there is a strong physiological link between over-activation of the stress response and regulation of the tumor microenvironment [13][14][15] . In mechanistic animal studies where stress can demonstrably be reproduced, chronic responses to stress influence processes involved in tumorigenesis [16][17][18][19] . However, observational studies assessing self-report of stressful life events and cancer outcomes have generally been inconsistent [20][21][22][23][24][25] .Epidemiological studies show positive associations between higher levels of AL indices and cardiovascular disease (CVD), as well as mortality risk 26,27 . However, we are not aware of any studies that have examined an index of AL with cancer outcomes. With cancer being the second leading cause of de...

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Section: Discussionmentioning

confidence: 96%

Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

Acheampong

Jiang

Ziogas

et al. 2020

Sci Rep

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“…We add to this literature by demonstrating that a setting-specific form of racial discrimination-racially-motivated housing discrimination-was independently associated with AL score after accounting for other situations in which discrimination had been experienced in the same time period. AL is an aggregate preclinical marker of the pathophysiologic processes that precede the onset of disease, and a 10-year predictor of morbidity, all-cause mortality, and cause-specific mortality across young, middle and older age adults [20,21]. Thus, the increased AL observed among those who experienced HD in this study may serve as a key etiologic pathway that links housing discrimination to the adverse health outcomes associated with this experience in the literature [3,[6][7][8][9][10][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Allostatic load (AL) is an aggregate measure of wear and tear on the body due to the chronic activation of allostasis [19]. Increased AL is a preclinical marker of the pathophysiologic processes that precede the onset of disease, and a 10-year predictor of morbidity, all-cause mortality, and cause-specific mortality across young, middle and older age adults [20,21].…”

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confidence: 99%

The impact of racially-motivated housing discrimination on allostatic load among Indigenous university students

Currie

Motz

Copeland

2019

Preprint

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Background Allostatic load (AL) is an aggregate measure of wear and tear on the body due to the chronic activation of the stress response system. The goal of this study was to examine the association between racially-motivated housing discrimination and AL score within a sample of Indigenous university students.Methods Data for this cross-sectional study were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 ( N = 104; Mean age = 27.8 years). An item adapted from the Experience of Discrimination Scale was to assess racially-motivated housing discrimination in the past 12 months. AL was measured as a composite of 7 biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for age, income, parenthood, and other situations in which discrimination had been experienced.Results Indigenous university students who experienced racially-motivated housing discrimination in the past year (16.8% of the sample) had an average AL score of approximately 4, which was almost double that of their peers who had not. In an adjusted model. racially-motivated housing discrimination was associated with a-1.5 point increase in AL score. This model explained 35% of the adjusted variance in AL score, of which racially-motivated housing discrimination explained 24% ( R 2 Change = 0.24, F Change = 32.52, Sig. F Change p <0.001).Conclusions Indigenous adults who experienced racially-motivated housing discrimination in the past year had early and more pronounced wear and tear on neuroendocrine, cardiovascular, metabolic, and immune system functioning in young and middle adulthood than Indigenous peers who did not. These findings combine with others to highlight the need for increased efforts to prevent racially-motivated housing discrimination in urban centres.

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“…Based on previous research [2,9,14,23] and availability of data in the CLHLS, we selected nine biomarkers to construct AL: heart rate, systolic BP (SBP), and diastolic BP (DBP), body mass index (BMI), total cholesterol, high density lipoprotein (HDL) cholesterol, glucose, triglyceride, and C-reactive protein (CRP). BMI, heart rate, SBP, and DBP were collected from physical examinations.…”

Section: Calculation Of Al Scorementioning

confidence: 99%

“…Allostatic load (AL) is conceptualized as the cumulative wear and tear on multiple physiological systems resulting from repeated adaptation to stressors [17,23,24]. In the absence of a gold standard, many operational de nitions of AL have been proposed.…”

Section: Introductionmentioning

confidence: 99%

The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

Zhang

Yan

Chen

et al. 2020

Preprint

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Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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Allostatic load as a predictor of all-cause and cause-specific mortality in the general population: Evidence from the Scottish Health Survey

Cited by 77 publications

References 32 publications

Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

The impact of racially-motivated housing discrimination on allostatic load among Indigenous university students

The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

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