High allostatic load linked to all-cause mortality among patients with breast cancer
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Key takeaways:
- Researchers observed the highest adjusted mean allostatic load among Black patients.
- High allostatic load appeared associated with a 46% increased risk for mortality.
High allostatic load appeared associated with increased risk for all-cause mortality among patients with breast cancer, according to study results published in JAMA Network Open.
The findings additionally showed associations between high allostatic load, a cumulative measure of physiologic damage related to socioenvironmental stressors, and Black race, unpartnered marital status and having government insurance, researchers concluded.
Rationale and methodology
Previous research has shown correlations of elevated allostatic load with larger tumor size ER-negative tumors among patients with breast cancer, according to study background.
However, the association between allostatic load and all-cause mortality among these patients is not fully known.
Samilia Obeng-Gyasi, MD, MPH, breast surgical oncologist at The Ohio State University Comprehensive Cancer Center, and colleagues sought to examine the association between allostatic load and all-cause mortality among 4,459 patients (median age, 59 years; 86.6% non-Hispanic white) diagnosed with stage I to stage III breast cancer between 2012 and 2020.
Researchers retrieved biomarkers for allostatic load from The Ohio State University Cancer Registry and electronic medical records.
They derived the allostatic load measure from four physiologic systems — cardiovascular, metabolic, renal and immune — and calculated allostatic load using the quartile method.
All-cause mortality served as the main outcome.
Findings, next steps
Researchers calculated a mean allostatic load of 2.6. They observed the highest adjusted mean allostatic load among Black vs. white patients (adjusted relative ratio [aRR] = 1.11; 95% CI 1.04-1.18), single patients vs. those married/living as married (aRR = 1.06; 95% CI, 1-1.12) and those with government-supplied insurance vs. private insurance (Medicaid aRR = 1.14; 95% CI, 1.07-1.21; Medicare aRR = 1.11; 95% CI, 1.03-1.19).
“These results support existing studies suggesting patients experiencing persistent socioeconomic marginalization have higher biological correlates of stress, operationalized as allostatic load, than their socioeconomically privileged counterparts,” the researchers wrote.
Results additionally showed that after adjusting for sociodemographic, clinical and treatment factors, high allostatic load appeared associated with a 46% increased risk for mortality (HR = 1.46; 95% CI, 1.11-1.93) compared with low allostatic load.
Moreover, patients in the third (HR = 1.53; 95% CI, 1.07-2.18) and fourth allostatic load quartile (HR = 1.79; 95% CI, 1.16-2.75) experienced a significantly increased risk for mortality than patients in the first allostatic load quartile.
Researchers observed a significant dose-dependent association between increased allostatic load and a higher risk for all-cause mortality.
Allostatic load remained significantly associated with higher all-cause mortality even after adjustment for the Charlson Comorbidity Index, according to the researchers.
Limitations of the study included selection bias and generalizability due to the use of data from a single institution. In addition, the allostatic load measure was limited by the availability of biomarker data in The Ohio State University Cancer Registry and electronic medical records, and not all biomarkers were collected at the same time, researchers noted.
“Future research is needed to discover the biological and behavioral mechanisms of the association between allostatic load and mortality,” researchers wrote.
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