Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019

Justin Xavier Moore, Sydney Elizabeth Andrzejak, Malcolm S. Bevel, Samantha R. Jones, Martha S. Tingen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Several studies suggest that chronic stress may be associated with increased risk of cancer mortality. Our study sought to determine the association between allostatic load (AL), a measure of cumulative stress, and risk of cancer death; and whether these associations varied by race/ethnicity. Methods: We performed retrospective analysis using National Health and Nutrition Examination Survey (NHANES) years 1988 through 2010 linked with the National Death Index through December 31, 2019. We fit Fine & Gray Cox proportional hazards models to estimate sub-distribution hazard ratios (SHRs) of cancer death between high and low AL status (models adjusted for age, sociodemographics, and comorbidities). Results: In fully adjusted models, high AL was associated with a 14% increased risk of cancer death (adjusted (SHR): 1.14, 95% CI: 1.04–1.26) among all participants and a 18% increased risk of cancer death (SHR:1.18, 95% CI: 1.03–1.34) among Non-Hispanic White (NH-White) adults. When further stratified by age (participants aged <40 years), high AL was associated with a 80% increased risk (SHR: 1.80, 95% CI: 1.35–2.41) among all participants; a 95% increased risk (SHR: 1.95, 95% CI: 1.22–3.12) among NH-White adults; a 2-fold (SHR: 2.06, 95% CI: 1.27–3.34) increased risk among Non-Hispanic Black (NH-Black) adults; and a 36% increased risk among Hispanic adults (SHR: 1.36, 95% CI: 0.70–2.62). Conclusions: Overall, the risk of cancer death was associated with high AL; however, when stratified among NH-Black and Hispanic adults this association was slightly attenuated. Impact: High AL is associated with increased risk of overall cancer death, and future studies should delineate the association between AL and cancer-specific mortality to better understand the causal mechanisms between cumulative stress and cancer.

Original languageEnglish
Article number101185
JournalSSM - Population Health
Volume19
DOIs
StatePublished - Sep 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors

Keywords

  • Cancer
  • Cumulative stress
  • Disparities
  • Life-course
  • Psychosocial stress
  • Race

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

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