Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort
Abstract
1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Study Subjects
4.2. Exposure
4.3. Outcome
4.4. Covariates
4.5. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics § | Black ‡ | White ‡ | p | |
---|---|---|---|---|
Age, years, mean (SD) | 64.1 (9.2) | 65.4 (9.5) | <0.001 | |
Comorbidity score, mean (SD) | 2.02(1.36) | 1.79(1.4) | <0.001 | |
Allostatic load, mean (SD) * | 2.42 (1.50) | 1.99 (1.39) | <0.001 | |
High allostatic load, % (SE) † | 44.6 (0.4) | 33.4 (0.3) | <0.001 | |
Allostatic load, mean (SD) by patient characteristics | ||||
Sex | Female | 2.49 (1.46) | 1.88 (1.35) | <0.001 |
Male | 2.29 (1.56) | 2.09 (1.42) | ||
Region | Stroke Belt | 2.44 (1.49) | 2.01 (1.40) | 0.028 |
Stroke Buckle | 2.34 (1.48) | 1.99 (1.37) | ||
Non-Belt | 2.43 (1.51) | 1.97 (1.38) | ||
Annual Income | ≥USD 75,000 | 1.98 (1.42) | 1.63 (1.30) | <0.001 |
USD 35,000 to USD 74,000 | 2.18 (1.45) | 1.95 (1.36) | ||
USD 20,000 to USD 34,000 | 2.47 (1.49) | 2.21 (1.41) | ||
<USD 20,000 | 2.68 (1.51) | 2.38 (1.43) | ||
Refused | 2.52 (1.52) | 1.89 (1.37) | ||
Education | College + | 2.18 (1.48) | 1.78 (1.34) | 0.035 |
Some college | 2.35 (1.45) | 2.05 (1.39) | ||
High school | 2.47 (1.51) | 2.12 (1.39) | ||
<High School | 2.74 (1.51) | 2.47 (1.44) | ||
Alcohol | None | 2.50 (1.51) | 2.14 (1.41) | 0.724 |
Moderate | 2.20 (1.47) | 1.81 (1.34) | ||
Heavy | 2.08 (1.33) | 1.66 (1.32) | ||
Physical activity | None | 2.68 (1.54) | 2.28 (1.43) | 0.19 |
1–3 times/week | 2.34 (1.46) | 1.91 (1.36) | ||
≥4 times /week | 2.15 (1.44) | 1.78 (1.33) | ||
Smoking | Never | 2.39 (1.50) | 1.87 (1.35) | 0.087 |
Past | 2.46 (1.50) | 2.08 (1.40) | ||
Current | 2.41 (1.49) | 2.12 (1.43) | ||
Diabetes | Yes | 2.94 (1.51) | 2.79 (1.41) | <0.001 |
No | 2.20 (1.44) | 1.84 (1.33) | ||
BMI | Normal | 1.60 (1.35) | 1.28 (1.13) | 0.379 |
Overweight/obese | 2.60 (1.47) | 2.28 (1.38) | ||
Biomarkers comprising AL score calculation | ||||
BUN, mg/dL, median (IQR) | 15.0 (12.0–19.0) | 16.9 (13.6–20.0) | <0.001 | |
Albumin, g/dL, mean (SD) | 4.11(0.33) | 4.21(0.32) | <0.001 | |
CRP, mg/L, median (IQR) | 3.1 (1.2–7.2) | 1.9 (0.8–4.6) | <0.001 | |
Creatinine, mg/dL, median (IQR) | 0.9 (0.7–1.1) | 0.8 (0.7–0.9) | <0.001 | |
DBP, mmHg, mean (SD) | 78.44(10.08) | 75.16(9.19) | <0.001 | |
SBP, mmHg, mean (SD) | 130.77(17.35) | 125.37(15.8) | <0.001 | |
HDL, mg/dL, median (IQR) | 51.0 (42.0–62.0) | 48.0 (39.0–60.0) | <0.001 |
Characteristics‡ | High AL (≥3) * (N = 11,280) | Low AL (<3) (N = 18,421) | p | |
---|---|---|---|---|
Age, years, mean (SD) | 66.0 (9.3) | 64.2 (9.4) | <0.001 | |
Sex (% female) | 6274 (55.6) | 10,088(54.7) | 0.149 | |
Race (% Black) | 5454 (48.3) | 6770 (36.7) | <0.001 | |
Region | Stroke Belt | 3980 (35.2) | 6308 (34.2) | 0.009 |
Stroke Buckle | 2261 (20.0) | 3956 (21.4) | ||
Non-Belt | 5039 (44.6) | 8157 (44.2) | ||
Annual Income | ≥USD 75,000 | 1161 (10.3) | 3537 (19.23) | <0.001 |
USD 35,000 to USD 74,000 | 3040 (26.9) | 5772 (31.3) | ||
USD 20,000 to USD 34,000 | 3054 (27.1) | 4123 (22.4) | ||
<USD 20,000 | 2631 (23.3) | 2715 (14.7) | ||
Refused | 1394 (12.4) | 2274 (12.3) | ||
Education | College + | 3180 (28.2) | 7165 (38.9) | <0.001 |
Some college | 3012 (26.7) | 4965 (26.9) | ||
High school | 3175 (28.1) | 4494 (24.4) | ||
<High School | 1913 (16.9) | 1797 (9.7) | ||
Alcohol | None | 7927 (70.3) | 10,902 (59.2) | <0.001 |
Moderate | 3022 (26.8) | 6673 (36.2) | ||
Heavy | 331 (2.9) | 846 (4.6) | ||
Physical activity | None | 4685 (41.5) | 5385 (29.2) | <0.001 |
1–3 times/week | 3900 (34.6) | 7079 (38.4) | ||
≥4 times/week | 2695 (23.9) | 5957 (32.3) | ||
Smoking | Never | 4811 (42.6) | 8690 (47.2) | <0.001 |
Past | 4689 (41.6) | 7226 (39.2) | ||
Current | 1780 (15.8) | 2505 (13.6) | ||
Diabetes (% yes) | 3630 (32.2) | 2664 (14.5) | <0.001 | |
BMI | Normal | 1363 (12.1) | 6150 (33.4) | <0.001 |
Overweight/obese | 9917 (87.9) | 12,271 (66.6) | ||
BUN, mg/dL, median (IQR) | 19.0 (14.6–23.0) | 15.0 (12.0–18.0) | <0.001 | |
Comorbid score, mean (SD) | 2.5 (1.4) | 1.5 (1.3) | <0.001 | |
Albumin, g/dL, mean (SD) | 4.1 (0.4) | 4.2 (0.3) | <0.001 | |
CRP, mg/L, median (IQR) | 4.8 (2.5–9.0) | 1.6 (0.8–3.2) | <0.001 | |
Creatinine, mg/dL, median (IQR) | 0.9 (0.8–1.2) | 0.8 (0.7–1.0) | <0.001 | |
DBP, mmHg, mean (SD) | 79.5 (11.0) | 74.7 (8.4) | <0.001 | |
SBP, mmHg, mean (SD) | 135.1 (18.3) | 123.0 (13.7) | <0.001 | |
HDL, mg/dL, median (IQR) | 44.0 (36.0–56.0) | 52.0 (43.9–64.0) | <0.001 |
Models | Overall (N = 29,701) †‡ | Black (N = 12,224) †‡ | White (N = 17,476) †‡ | |||
---|---|---|---|---|---|---|
Allostatic Load | All-Cause Mortality ‡ | Cancer mortality ‡ | All-Cause mortality ‡ | Cancer Mortality ‡ | All-Cause mortality ‡ | Cancer mortality ‡ |
Deaths | 4622 | 1237 | 2055 | 513 | 2607 | 724 |
Crude * | 1.35 (1.33, 1.38) | 1.15 (1.11, 1.19) | 1.32 (1.28, 1.36) | 1.09 (1.03, 1.16) | 1.37 (1.34, 1.41) | 1.20 (1.14, 1.26) |
Model 1 * | 1.32 (1.29, 1.34) | 1.11 (1.07, 1.16) | 1.29 (1.25, 1.33) | 1.06 (1.00, 1.13) | 1.31 (1.28, 1.35) | 1.14 (1.09, 1.21) |
Model 2 * | 1.30 (1.28, 1.33) | 1.11 (1.06, 1.15) | - | - | - | - |
Model 3 * | 1.27 (1.24, 1.30) | 1.08 (1.04, 1.13) | 1.33 (1.29, 1.37) | 1.11 (1.04, 1.18) | 1.31 (1.28, 1.35) | 1.15 (1.09, 1.22) |
Model 4 * | 1.24 (1.22,1.27) | 1.07 (1.03,1.12) | 1.26 (1.22,1.30) | 1.06 (0.99,1.13) | 1.23 (1.20,1.27) | 1.08 (1.03,1.14) |
Race Ω | ||||||
Black | 1.05 (0.99, 1.12) | 1.03 (0.92,1.17) | - | - | - | |
White (Ref) | - | - | - |
Allostatic Load | Normal BMI (n = 7299) † | Overweight/Obese (N = 22,401) † | ||
---|---|---|---|---|
All-Cause mortality ‡ | Cancer mortality ‡ | All-Cause mortality ‡ | Cancer mortality ‡ | |
Deaths | 1414 | 407 | 3248 | 830 |
Crude * | 1.56 (1.50, 1.63) | 1.40 (1.30, 1.50) | 1.41 (1.38, 1.44) | 1.17 (1.11, 1.23) |
Model 1 * | 1.41 (1.35, 1.47) | 1.29 (1.19, 1.39) | 1.36 (1.33, 1.40) | 1.13 (1.07, 1.18) |
Model 2 * | 1.38 (1.32, 1.44) | 1.27 (1.17, 1.37) | 1.35 (1.32, 1.39) | 1.12 (1.07, 1.18) |
Model 3 * | 1.34 (1.28, 1.40) | 1.22 (1.13, 1.33) | 1.32 (1.29, 1.35) | 1.10 (1.05, 1.16) |
Model 4 * | 1.29 (1.23, 1.35) | 1.17 (1.08, 1.28) | 1.29 (1.26, 1.32) | 1.09 (1.03, 1.14) |
Race Ω | ||||
Black | 1.18 (1.05, 1.33) | 1.11 (0.89, 1.38) | 1.09 (1.01, 1.17) | 1.06 (0.91, 1.23) |
White (Ref) | - | - | - | - |
Allostatic Load | Age < 65 years (N = 15,008) † | Age ≥65 years (N = 14,692) † | ||
---|---|---|---|---|
All-Cause mortality ‡ | Cancer mortality ‡ | All-Cause mortality ‡ | Cancer mortality ‡ | |
Deaths | 1106 | 320 | 3556 | 917 |
Crude | 1.47 (1.42, 1.53) | 1.17 (1.09, 1.26) | 1.28 (1.25, 1.31) | 1.11 (1.06, 1.16) |
Model 1 * | 1.46 (1.40, 1.51) | 1.15 (1.07, 1.24) | 1.27 (1.24, 1.30) | 1.10 (1.05, 1.15) |
Model 2 * | 1.43 (1.37, 1.49) | 1.13 (1.04, 1.22) | 1.26 (1.23, 1.29) | 1.10 (1.05, 1.15) |
Model 3 * | 1.36 (1.31,1.42) | 1.07(0.99, 1.16) | 1.24 (1.21, 1.27) | 1.08 (1.03, 1.13) |
Model 4 * | 1.34 (1.28, 1.39) | 1.06 (0.98, 1.15) | 1.22 (1.19, 1.25) | 1.07 (1.02, 1.12) |
Allostatic Load Components | Continuous * | High vs. Low *† | Continuous * | High vs. Low *† |
---|---|---|---|---|
All-Cause mortality ‡ | Cancer mortality ‡ | |||
Overall | ||||
Deaths | 4622 | 4622 | 1237 | 1237 |
CRP | 1.01 (1.01, 1.02) | 1.50 (1.41, 1.59) | 1.01 (1.01, 1.02) | 1.30 (1.16, 1.46) |
Albumin | 0.60 (0.53, 0.67) | 1.44 (1.31, 1.59) | 0.80 (0.64, 1.00) | 1.12 (0.90, 1.39) |
BUN | 1.03 (1.02, 1.04) | 1.46 (1.35, 1.57) | 1.01 (1.00, 1.02) | 1.12 (0.97, 1.28) |
Total Cholesterol | 1.00 (1.00,1.00) | 1.00 (0.90, 1.11) | 1.00 (1.00, 1.00) | 0.95 (0.78, 1.16) |
Creatinine | 1.37 (1.30, 1.43) | 2.10 (1.93, 2.28) | 1.14 (1.03, 1.25) | 1.19 (0.98, 1.45) |
HDL | 1.00 (0.99, 1.00) | 1.13 (1.05, 1.21) | 1.00 (0.99, 1.00) | 1.07 (0.93, 1.23) |
DBP | 1.00 (1.00, 1.00) | 1.15 (1.03, 1.28) | 0.99 (0.99, 1.00) | 0.82 (0.65, 1.03) |
SBP | 1.01 (1.00,1.01) | 1.29 (1.21, 1.38) | 1.00 (1.00, 1.00) | 1.02 (0.90, 1.17) |
WC | 1.01 (1.01, 1.01) | 1.06(0.99,1.14) | 1.00 (1.00, 1.00) | 0.91 (0.80, 1.04) |
Blacks | ||||
Deaths | 2055 | 2055 | 513 | 513 |
CRP | 1.01 (1.01, 1.02) | 1.37 (1.24, 1.50) | 1.01 (1.01, 1.02) | 1.08 (0.90, 1.29) |
Albumin | 0.52 (0.44, 0.61) | 1.57 (1.38, 1.78) | 0.74 (0.52, 1.05) | 1.12 (0.83, 1.50) |
BUN | 1.03 (1.02, 1.04) | 1.57 (1.42, 1.75) | 1.01 (1.00, 1.02) | 1.13 (0.92, 1.39) |
Total Cholesterol | 1.00 (1.00, 1.00) | 1.06 (0.92, 1.23) | 1.00 (1.00, 1.00) | 0.98 (0.73, 1.31) |
Creatinine | 1.34 (1.27, 1.41) | 2.25 (2.00, 2.52) | 1.15 (1.04, 1.27) | 1.24 (0.95, 1.62) |
HDL | 1.00 (0.99, 1.00) | 1.15 (1.03, 1.29) | 1.00 (0.99, 1.00) | 1.12 (0.89, 1.40) |
DBP | 1.00 (1.00, 1.01) | 1.20 (1.05, 1.37) | 0.99 (0.98, 1.00) | 0.88 (0.65, 1.17) |
SBP | 1.01 (1.01, 1.01) | 1.34 (1.22, 1.47) | 1.00 (1.00, 1.01) | 1.08 (0.89, 1.31) |
WC | 1.01 (1.01, 1.01) | 0.98 (0.88, 1.08) | 1.00 (0.99, 1.00) | 0.89(0.73, 1.09) |
Whites | ||||
Deaths | 2607 | 2607 | 704 | 704 |
CRP | 1.02 (1.02, 1.03) | 1.61 (1.48, 1.74) | 1.02 (1.01, 1.02) | 1.48 (1.27, 1.72) |
Albumin | 0.68 (0.58, 0.80) | 1.32 (1.15, 1.53) | 0.84 (0.63, 1.13) | 1.15 (0.86, 1.54) |
BUN | 1.03 (1.03, 1.04) | 1.37 (1.23, 1.52) | 1.00 (0.99,1.02) | 1.11 (0.93, 1.33) |
Total Cholesterol | 1.00 (1.00, 1.00) | 0.95 (0.82, 1.09) | 1.00 (1.00, 1.00) | 0.93 (0.71, 1.21) |
Creatinine | 1.45 (1.34, 1.58) | 1.93 (1.70, 2.19) | 1.08 (0.86, 1.36) | 1.11 (0.83, 1.48) |
HDL | 1.00 (0.99, 1.00) | 1.11 (1.01, 1.21) | 1.00 (0.99, 1.00) | 1.04 (0.88, 1.24) |
DBP | 1.00 (0.99, 1.00) | 1.06 (0.88, 1.27) | 0.99 (0.98, 1.00) | 0.74 (0.51, 1.08) |
SBP | 1.00 (1.00, 1.01) | 1.25 (1.14, 1.37) | 1.00 (0.99, 1.00) | 0.98 (0.81, 1.17) |
WC | 1.01 (1.01, 1.01) | 1.14 (1.04, 1.26) | 1.00 (1.00, 1.01) | 0.94 (0.79, 1.13) |
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Akinyemiju, T.; Wilson, L.E.; Deveaux, A.; Aslibekyan, S.; Cushman, M.; Gilchrist, S.; Safford, M.; Judd, S.; Howard, V. Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort. Cancers 2020, 12, 1695. https://doi.org/10.3390/cancers12061695
Akinyemiju T, Wilson LE, Deveaux A, Aslibekyan S, Cushman M, Gilchrist S, Safford M, Judd S, Howard V. Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort. Cancers. 2020; 12(6):1695. https://doi.org/10.3390/cancers12061695
Chicago/Turabian StyleAkinyemiju, Tomi, Lauren E Wilson, April Deveaux, Stella Aslibekyan, Mary Cushman, Susan Gilchrist, Monika Safford, Suzanne Judd, and Virginia Howard. 2020. "Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort" Cancers 12, no. 6: 1695. https://doi.org/10.3390/cancers12061695
APA StyleAkinyemiju, T., Wilson, L. E., Deveaux, A., Aslibekyan, S., Cushman, M., Gilchrist, S., Safford, M., Judd, S., & Howard, V. (2020). Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort. Cancers, 12(6), 1695. https://doi.org/10.3390/cancers12061695