TY - JOUR
T1 - Exploring racial disparities on the association between allostatic load and cancer mortality
T2 - A retrospective cohort analysis of NHANES, 1988 through 2019
AU - Moore, Justin Xavier
AU - Andrzejak, Sydney Elizabeth
AU - Bevel, Malcolm S.
AU - Jones, Samantha R.
AU - Tingen, Martha S.
N1 - Funding Information:
Funding: Dr. Moore was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number K01MD015304. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was supported at least in part through the Georgia Cancer Center Paceline funding mechanism.
Publisher Copyright:
© 2022 The Authors
PY - 2022/9
Y1 - 2022/9
N2 - 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.
AB - 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.
KW - Cancer
KW - Cumulative stress
KW - Disparities
KW - Life-course
KW - Psychosocial stress
KW - Race
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U2 - 10.1016/j.ssmph.2022.101185
DO - 10.1016/j.ssmph.2022.101185
M3 - Article
AN - SCOPUS:85135693232
SN - 2352-8273
VL - 19
JO - SSM - Population Health
JF - SSM - Population Health
M1 - 101185
ER -