In a study reported in JAMA Network Open, Samilia Obeng-Gyasi, MD, MPH, and colleagues found that allostatic load—defined as “a cumulative measure of physiologic damage secondary to cognitive-emotional responses and perceptions to socioenvironmental stressors (ie, low socioeconomic status)”—was associated with all-cause mortality among patients with stage I to III breast cancer.
Samilia Obeng-Gyasi, MD, MPH
Study Details
The study involved 4,459 patients from the Ohio State University Cancer Registry who underwent surgical treatment for stage I to III breast cancer between January 2012 and December 2020.
The allostatic load score used in the study was derived from four physiologic systems:
- Cardiovascular: ie, heart rate and blood pressure (systolic and diastolic)
- Metabolic: ie, body mass index, alkaline phosphatase, blood glucose, and albumin
- Renal: ie, creatinine and blood urea nitrogen
- Immune: ie, white blood cell count.
High allostatic load was defined as a score higher than median, and low allostatic load was defined as a score below median.
Key Findings
Adjusted mean allostatic load scores were higher for Black vs White patients (adjusted rate ratio [aRR] = 1.11, 95% confidence interval [CI] = 1.04–1.18); single patients (aRR = 1.06, 95% CI = 1.00–1.12); widowed, separated, or divorced patients (aRR = 1.08, 95% CI = 1.03–1.13) vs married/living as married patients; and patients with Medicaid (aRR = 1.14, 95% CI = 1.07–1.21) or Medicare (aRR = 1.11, 95% CI = 1.03–1.19) vs private insurance.
In analysis adjusting for sociodemographic, clinical, and treatment factors, high vs low allostatic load was associated with significantly increased risk of all-cause mortality (hazard ratio [HR] = 1.46, 95% CI = 1.11–1.93). Compared with patients in the first (lowest) quartile of allostatic load, those in the third quartile (HR = 1.53, 95% CI = 1.07–2.18) and fourth quartile (HR = 1.79, 95% CI = 1.16–2.75) had a significantly increased risk of mortality.
High allostatic load remained significantly associated with a greater risk of all-cause mortality in analysis further adjusted for Charlson comorbidity index. Significant dose-dependent associations between increased allostatic load and higher risk of all-cause mortality were observed in dose-response analyses.
The investigators concluded, “These findings suggest increased allostatic load is reflective of socioeconomic marginalization and associated with all-cause mortality in patients with breast cancer.”
Dr. Obeng-Gyasi, of the Division of Surgical Oncology, The Ohio State University, Columbus, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by a Conquer Cancer Breast Cancer Research Foundation Advanced Clinical Research Award and others. For full disclosures of the study authors, visit jamanetwork.com.
