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

doi:10.1016/j.ssmph.2022.101185

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

SSM Popul Health. 2022 Jul 31:19:101185. doi: 10.1016/j.ssmph.2022.101185. eCollection 2022 Sep.

Authors

Justin Xavier Moore^{1

2}, Sydney Elizabeth Andrzejak¹, Malcolm S Bevel¹, Samantha R Jones¹, Martha S Tingen¹

Affiliations

¹ Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA.
² Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA.

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.

Keywords: AL, Allostatic Load; BHS, Biological Health Score; BIPOC, Black, Indigenous, and People of Color; BMI, Body Mass Index; CI, Confidence Interval; CRP, C-reactive protein; CRT, Criticial Race Theory; Cancer; Cumulative stress; DBP, Diastolic Blood Pressure; Disparities; ICD-10, International Statistical Classification of Diseases, Injuries, and Causes of Death; Life-course; NCHS, National Center for Health Statistics; NDI, National Death Index; NH-Black, Non-Hispanic Black; NH-White, Non-Hispanic White; NHANES, National Health and Nurtrition Examination Survey; PIR, Poverty Income Ratio; Psychosocial stress; REGARDS, REasons for Geographic and Racial Differnces in Stroke; Race; SBP, Systolic Blood Pressure; U.S., United States; UK, United Kingdom.