Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988–2018

Moore, Justin Xavier; Bevel, Malcolm; Aslibekyan, Stella; Akinyemiju, Tomi

doi:10.1016/j.ypmed.2021.106483

Cited by 30 publications

(32 citation statements)

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“…Racial minorities, specifically Black women, are exposed to higher levels of racial discrimination that may in turn explain the prolonged activation of the body’s natural stress response [ 5 , 11 , 33 ]. Specifically, Black women tend to have higher AL than their white women and Black men counterparts [ 7 ], despite the association of lower AL level with reported incidents of very-high institution-specific racial discrimination in a prior study [ 33 ]. This increased racial stress exposure may lead to greater experiences of anger, and poorer quality of life which in turn may lead to higher levels of cumulative stress and AL [ 35 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…We performed several sequential adjusted modified Poisson regression models for estimating relative prevalence of high AL by educational attainment [ 30 – 32 ]. We adjusted for potential confounders including: age groups, total number of pregnancies, age at menarche, PIR, depressive disorder, smoking status, any history of cancer, congestive heart failure, and heart attack [ 5 , 7 , 33 ]. We estimated the variance for point estimates within the modified Poisson regression utilizing the delete-1 jackknife (resampling) method [ 30 – 32 ].…”

Section: Methodsmentioning

confidence: 99%

“…For instance, a recent systematic review of 267 studies reported that higher AL was associated with poorer health outcomes [ 6 ]. Notably, the effects of AL vary dramatically by social identities such as race, ethnicity, age, gender, and sexual orientations [ 7 ]. Regardless of the time between 1988 and 2018, Moore et al reported that non-Hispanic Black (henceforth, Black) people had up to a 29.2% increased risk of high AL compared to their non-Hispanic white counterparts [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Notably, the effects of AL vary dramatically by social identities such as race, ethnicity, age, gender, and sexual orientations [ 7 ]. Regardless of the time between 1988 and 2018, Moore et al reported that non-Hispanic Black (henceforth, Black) people had up to a 29.2% increased risk of high AL compared to their non-Hispanic white counterparts [ 7 ]. Even when accounting for socioeconomic status, Black women had the highest allostatic load when compared to any other race-gender specific subgroup including white women and men, and Black men [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moore et al observed that age-adjusted mean AL scores were highest among Black women at the end of the 30-year period [ 7 ]. However, when considering within-group differences among Black women, appraisal of stressors such as racial discrimination can vary when considered with socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

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Examining educational attainment and allostatic load in non-Hispanic Black women

et al. 2022

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Background Research suggests that non-Hispanic Black (henceforth, Black) women and people with lower educational attainment have higher levels of allostatic load (AL). This study sought to determine the association between educational attainment and AL among a large sample of Black women. Methods We analyzed data among 4177 Black women from the National Health and Nutrition Examination Survey years 1999–2018. AL score was defined as the total for abnormal measures of eight biomarkers. We further categorized participants with AL score greater than or equal to 4 as having high AL. We calculated mean estimates of total allostatic load scores using generalized linear models. We performed modified Poisson Regression models with robust variance estimation to estimate prevalence ratios (PRs) of high allostatic load and their associated 95% confidence intervals (CIs) by educational attainment. Results Black women with a college degree or higher had the lowest prevalence of high allostatic load (31.8% vs. 42.7%, 36.3%, 36.6%), and age adjusted mean allostatic load scores (mean = 1.90 vs. mean = 2.34, mean = 1.99, mean = 2.05) when compared to Black women with less than a high school diploma, high school diploma or GED, and some college or associates degree respectively. Even after accounting for age, poverty-to-income ratio, smoking, congestive heart failure, and heart attack, Black college graduates had an 14.3% lower prevalence of high allostatic load (PR = 0.857, 95% CI 0.839–0.876) when compared to Black women with lower educational attainment. Conclusions Black women with a baccalaureate degree or higher educational attainment had lower allostatic load compared to Black women with less than a high school education. This finding further confirms higher education is a social determinant of health. Future research should explore differences in AL by more granular degree types.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Examining educational attainment and allostatic load in non-Hispanic Black women

et al. 2022

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Association of Allostatic Load With All-Cause Mortality in Patients With Breast Cancer

Obeng‐Gyasi

Elsaid

et al. 2023

JAMA Netw Open

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ImportanceElevated allostatic load (AL) has been associated with adverse socioenvironmental stressors and tumor characteristics that convey poor prognosis in patients with breast cancer. Currently, the association between AL and all-cause mortality in patients with breast cancer is unknown.ObjectiveTo examine the association between AL and all-cause mortality in patients with breast cancer.Design, Setting, and ParticipantsThis cohort study used data from an institutional electronic medical record and cancer registry at the National Cancer Institute Comprehensive Cancer Center. Participants were patients with breast cancer diagnoses (stage I-III) between January 1, 2012, through December 31, 2020. Data were analyzed from April 2022 through November 2022.ExposureAL was expressed as a summary score calculated by assigning 1 point for biomarkers in the worst sample quartile. High AL was defined as AL greater than the median.Main Outcomes and MeasuresThe main outcome was all-cause mortality. A Cox proportional hazard models with robust variance tested the association between AL and all-cause mortality.ResultsThere were 4459 patients (median [IQR] age, 59 [49-67] years) with an ethnoracial distribution of 3 Hispanic Black patients (0.1%), 381 non-Hispanic Black patients (8.5%), 23 Hispanic White patients (0.5%), 3861 non-Hispanic White patients (86.6%), 27 Hispanic patients with other race (0.6%), and 164 non-Hispanic patients with other race (3.7%). The mean (SD) AL was 2.6 (1.7). Black patients (adjusted relative ratio [aRR], those with 1.11; 95% CI, 1.04-1.18), single marital status (aRR, 1.06; 95% CI, 1.00-1.12), and those with government-supplied insured (Medicaid aRR, 1.14; 95% CI, 1.07-1.21; Medicare aRR, 1.11; 95% CI, 1.03-1.19) had a higher adjusted mean AL than those who were White, married/living as married, or privately insured, respectively. Adjusting for sociodemographic, clinical, and treatment factors, high AL was associated with a 46% increase in mortality risk (hazard ratio [HR], 1.46; 95% CI, 1.11-1.93) over low AL. Similarly, compared with patients in the first AL quartile, those in the third quartile (HR, 1.53; 95% CI, 1.07-2.18) and the fourth quartile (HR, 1.79; 95% CI, 1.16-2.75) had significantly increased risks of mortality. There was a significant dose-dependent association between increased AL and a higher risk of all-cause mortality. Furthermore, AL remained significantly associated with higher all-cause mortality after adjusting for the Charlson Comorbidity Index.Conclusions and RelevanceThese findings suggest increased AL is reflective of socioeconomic marginalization and associated with all-cause mortality in patients with breast cancer.

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Disparities in head and neck cancer incidence and trends by race/ethnicity and sex

2022

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Background The epidemiology of head and neck cancer (HNC) sites differ substantially. This study compares HNC incidence trends by site and demographic subgroups. Methods We used the U.S. Cancer Statistics Public Use Database to calculate HNC incidence rates per 100 000. We assessed trends with annual percent change (APC) longitudinally from 2001 to 2017. Results The oropharyngeal cancer incidence APC decreased from 4.38% (95% CI: 3.6, 5.1) to 2.93% (2.5, 3.3) in 2008 among White males. Oral cavity cancer incidence rose in Other race males (APC 2.5% [1.6, 3.36]) and White females (APC: 0.96% [0.7, 1.2]). Although decreasing (APC: −1.15% [−1.48, −0.83]), laryngeal cancer incidence remained disproportionately high among Black males. Conclusions Notable incidence trends occurred in non‐White groups at non‐oropharyngeal sites. With parity of smoking rates by race, differing sexual behaviors, and shifting demographics by race and sex, future studies of HNC trends should consider stratifying analyses to understand health disparities.

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Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988–2018

Cited by 30 publications

References 86 publications

Examining educational attainment and allostatic load in non-Hispanic Black women

Examining educational attainment and allostatic load in non-Hispanic Black women

Association of Allostatic Load With All-Cause Mortality in Patients With Breast Cancer

Disparities in head and neck cancer incidence and trends by race/ethnicity and sex

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