ASPO Abstracts
Allostatic load and risk of mortality in older cancer survivors: an analysis of the National Health and Nutrition Examination Survey 1999-2010
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2022
Abstract Body:
Purpose: To investigate the association between allostatic load and mortality in older cancer survivors. Methods: A total of 1,371 adults aged 60 years or older who survived for at least 1 year since cancer diagnosis were identified from the 1999-2010 National Health and Nutrition Examination Survey. Allostatic load score (ALS) was the exposure of interest and incorporated 9 indicators (systolic blood pressure, diastolic blood pressure, heart rate, total cholesterol, high-density lipoprotein, body mass index, glycohemoglobin, c-reactive protein, and albumin). We added 1 point to the ALS if any of the aforementioned indicators exceeded the normal level. The ALS was categorized as an ordinal variable to reflect low (0-1), moderate (2-3), and high (‚â•4) allostatic load. Our outcomes of interest were all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality. Death was identified by linkage to the National Death Index through December 31, 2015. The underlying cause of death was ascertained via ICD-10. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence intervals (CI) of mortality by categories of ALS, with ALS=0 or 1 as the reference. Results: In our study, 53.9% of the participants were male and 79.1% of them were white. The mean age of study participants at interview was 73.0 years (SD=7.2), with 33% of them aged 60 to 69 years, 39.6% aged 70 to 79 years, and 27.4% aged 80 years or older. A total of 573 participants died during the follow-up (median follow-up time: 8.0 years). Among them, 155 died of cancer and 114 died of CVD. Results from multivariable Cox proportional hazards models showed that higher ALS was positively associated with higher all-cause mortality (ALS=4-9 vs. ALS =0-1: aHR=1.50, 95% CI =1.16-1.93, p-trend<0.01) and higher cancer-specific mortality (ALS=4-9 vs. ALS =0-1: aHR=1.79, 95% CI =1.12-2.85, p-trend=0.02). The association between ALS and CVD-specific mortality was positive but non-significant (ALS=4-9 vs. ALS =0-1: aHR=1.72, 95% CI =0.95-3.09, p-trend=0.06). Conclusion: Our study suggests that older cancer survivors can have a higher risk of death if they are living with a high burden of allostatic load.
Keywords: cancer survivorship; mortality; allostatic load; epidemiology