Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort

Abstract

Among 29,701 Black and White participants aged 45 years and older in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, allostatic load (AL) was defined as the sum score of established baseline risk-associated biomarkers for which participants exceeded a set cutoff point. Cox proportional hazard regression was utilized to determine the association of AL score with all-cause and cancer-specific mortality, with analyses stratified by body-mass index, age group, and race. At baseline, Blacks had a higher AL score compared with Whites (Black mean AL score: 2.42, SD: 1.50; White mean AL score: 1.99, SD: 1.39; p < 0.001). Over the follow-up period, there were 4622 all-cause and 1237 cancer-specific deaths observed. Every unit increase in baseline AL score was associated with a 24% higher risk of all-cause (HR: 1.24, 95% CI: 1.22, 1.27) and a 7% higher risk of cancer-specific mortality (HR: 1.07, 95% CI: 1.03, 1.12). The association of AL with overall- and cancer-specific mortality was similar among Blacks and Whites and across age-groups, however the risk of cancer-specific mortality was higher among normal BMI than overweight or obese participants. In conclusion, a higher baseline AL score was associated with increased risk of all-cause and cancer-specific mortality among both Black and White participants. Targeted interventions to patient groups with higher AL scores, regardless of race, may be beneficial as a strategy to reduce all-cause and cancer-specific mortality.

Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients

“…Our study is the first to examine the relationship between AL and OS or PFS in a cohort of only patients with MM. Study findings of an association between AL and overall survival are consistent with prior studies on AL in other cancer patients [ 17 ]. Specifically, previous studies suggest increasing AL is associated with worse overall and cancer-specific survival [ 16 , 17 ].…”

“…Elevated AL has been linked to SDH such as low socioeconomic status and educational attainment [ 12 – 15 ]. Moreover, increased AL has been associated increased disease-specific and overall mortality in cancer patients [ 16 , 17 ]. Notably, individual components of AL have been independently associated with tumorigenesis, mortality, and patient-reported adverse events [ 18 – 20 ].…”

Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study

“…Determining cancer mortality in REGARDS has been previously described 20 . All REGARDS participants were contacted by phone to ascertain vital status every 6 months 19 .…”

Biology of Discrimination

“…Measurements of AL are heterogenous but typically comprised of primary mediators (eg, cortisol, norepinephrine), secondary outcomes of primary mediators (eg, systolic blood pressure, diastolic blood pressure, waist-to-hip ratio) and at times includes tertiary outcomes (eg, hypertension, cancer) [15]. To date, elevated AL has been implicated in cognitive and functional decline, premature death, and increased diseasespecific and all-cause mortality among cancer patients [14,16,17]. Furthermore, Geronimus et al's review of the National Health and Nutrition Examination Survey suggests AL can be used as a framework to understand the effects of structural inequalities entrenched in racism and discrimination on health outcomes [18].…”