Abstract TMP103: The Heavy Burden Of Allostatic Load On Long-term Survival After Stroke And Stroke-related Mortality

Abstract

Background: Measurement of allostatic load, quantified by the allostatic load index (ALI), is often utilized to evaluate the physiologic response to stress. Our objective was to assess whether allostatic load is associated with mortality after stroke or with stroke-specific mortality in the general population. Methods: Using data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File (National Death Index), we selected adults aged ≥ 25 years. Stroke was self-reported. We computed the weighted prevalence of each allostatic load index (ALI) category to obtain nationally representative estimates with higher ALI corresponding to higher stress burden. We evaluated the relationship between ALI category and mortality outcomes using the Cox proportional hazard model considering the survey design variables, adjusting for age, sex, education, marital status, and income. Results: Of 15,567 individuals included in the study, there were 48.3% ALI ≤ 1, 21.7% ALI = 2, and 30% ALI ≥ 3. Of 414 individuals with reported history of stroke there were 11.8% ALI ≤ 1, 22.1% ALI = 2, and 66.1% ALI ≥3. Higher ALI correlated with male sex, older age, lower education, married or widowed status, and lower income. In the population with history of prior stroke, those with ALI ≥ 3 had 2.7 times higher all-cause mortality and 4.5 times higher cardiovascular mortality compared to those with ALI ≤ 1 (Table). In the general population, the ALI ≥ 3 group had 1.8 times higher adjusted stroke mortality. Discussion: Baseline higher allostatic load predicts greater all-cause and cardiovascular mortality risk in stroke survivors and greater stroke mortality risk in the general population. A global approach towards addressing the modifiable indicators in the ALI may improve survival in these populations.