Individual-level social determinants of health and allostatic load/chronic toxic stress in men with prostate cancer

Background: Allostatic load (AL)/chronic toxic stress is linked to a higher risk of adverse cancer-specific and cardiac events in prostate cancer (PC) patients especially non-Hispanic Blacks (NHBs). We hypothesize that NHBs experience more adverse social determinants of health (SDOH) that increases this AL. Methods: We included men$18 years diagnosed with PC (2010–2022). Individual-level SDOH with 19 covariates across 4 domains was obtained. Pre-PC diagnosis AL was calculated as an ordinal measure (0–11). Components and cutoffs for the AL score: Each measure above the cutoff add 1 point to AL. Systolic blood pressure (BP) $140 mmHg, diastolic BP $90 mmHg, heart rate.100 bpm, total cholesterol (chol) $240 mg/dl, high-density lipoprotein chol #50 mg/dl, triglycerides $150 mg/dl, glycated hemoglobin $6.5, body mass index $30 kg/m2, glucose $110 mg/dl, C-reactive protein.3 mg/L and interleukin-6.1.8 pg/ml. A gradient-boosting Machine Learning model ranked AL predictors using SHAP scores (SS). Cubic splined from logistic regressions defined SDOH adversity cutoffs. Results: Among 4,258 patients (886 NHB), the median age was 69 (IQR 63–77). Most were former smokers (44.2%), and the median Charlson comorbidity score was 4 (IQR 2–7). In NHBs, the SDOH variables among the top 5 overall predictors of AL were annual income (SS=0.10), neighborhood murder index (SS=0.07), neighborhood median income (SS=0.06), and neighborhood car theft index (SS=0.05). Considering all the SDOH features analyzed, NHBs faced adversity in 12 of 19 SDOH features (63%; Table). Conclusions: SDOH related to the neighborhood, built environment, and economic stability, are crucial predictors of pre-PC diagnosis AL in NHBs. Research Sponsor: Department of Defense; American Heart Association.