Abstract 14831: Low Positive Social Determinants of Health Exposure Amplifies the Association Between Allostatic Load and Risk of Cardiovascular Mortality in Cancer and Non-Cancer Patients

Abstract

Introduction: Allostatic load (AL) is a measure of the biological “wear and tear” or physiological effects of chronic toxic stress exposure and the body’s adaptive responses over time. High AL is associated with an increased risk of death from cardiovascular disease and cancer. Hypothesis: We examined Positive Social Determinants of Health (PSDOH) exposure as a moderator for the effect of AL on the risk of cardiovascular-related death (CVD) among adults with and without a history of cancer. Methods: We conducted a retrospective cohort analysis of the National Health and Nutrition Examination Survey (NHANES) years 1999 through 2010 linked and followed up with the National Death Index through December 31, 2019. We fit age, race, and sex-adjusted Fine & Gray models to calculate sub-distribution hazard ratios (SHR) of CVD among adults exposed to high versus low levels of PSDOH, stratified by high and low AL status. AL was calculated using a nine-point score previously defined in NHANES literature that uses a combination of serum biomarkers as well as body mass index and blood pressure. PSDOH was calculated using a seven-point score previously defined in NHANES literature examining positive exposures of home ownership, health insurance, educational attainment greater than high school, food security, being above the federal poverty level, health care access, and living with a partner. Results: Among 22,775 eligible participants in this study, 1,939 (8.5%) had a history of cancer. In the full cohort, age, race, and sex-adjusted models found that low PSDOH exposure was associated with a 38% increased risk of CVD among high AL adults (SHR: 1.38, 95% CI: 1.22 - 1.56) and a 57% increased risk among low AL adults (SHR: 1.57, 95% CI: 1.32 - 1.87). Cancer history-stratified adjusted models are presented in Table 1. Conclusions: Low PSDOH exposure amplified the association between AL and CVD in all cohorts, with the highest increases in risk being seen among adults with a history of cancer.