Allostatic Load and Mortality in Patients With Breast Cancer

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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

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:

  1. Cardiovascular: ie, heart rate and blood pressure (systolic and diastolic)
  2. Metabolic: ie, body mass index, alkaline phosphatase, blood glucose, and albumin
  3. Renal: ie, creatinine and blood urea nitrogen
  4. 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

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.