Abstract
The concept of allostatic load (AL) refers to the idea of a global physiological ‘wear and tear’ resulting from the adaptation to the environment through the stress response systems over the life span. The link between socioeconomic position (SEP) and mortality has now been established, and there is evidence that AL may capture the link between SEP and mortality. In order to quantitatively assess the role of AL on mortality, we use data from the 1958 British birth cohort including eleven year mortality in 8,113 adults. Specifically, we interrogate the hypothesis of a cumulative biological risk (allostatic load) reflecting 4 physiological systems potentially predicting future risk of death (N = 132). AL was defined using 14 biomarkers assayed in blood from a biosample collected at 44 years of age. Cox proportional hazard regression analysis revealed that higher allostatic load at 44 years old was a significant predictor of mortality 11 years later [HR = 3.56 (2.3 to 5.53)]. We found that this relationship was not solely related to early-life SEP, adverse childhood experiences and young adulthood health status, behaviours and SEP [HR = 2.57 (1.59 to 4.15)]. Regarding the ability of each physiological system and biomarkers to predict future death, our results suggest that the cumulative measure was advantageous compared to evaluating each physiological system sub-score and biomarker separately. Our findings add some evidence of a biological embodiment in response to stress which ultimately affects mortality.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Cyrille Delpierre and Michelle Kelly-Irving these authors have contributed to this work.Health inequalities have been highlighted between socioeconomic groups within populations worldwide [1, 2]
Our study suggests that having a higher allostatic load score was significantly associated with an increased risk of all-cause premature mortality over an 11 year period
After controlling for early life socioeconomic position (SEP), other life course factors and health status, participants with a high allostatic load (AL) at 44 years old had a risk of dying before 55y almost 3 times higher as those with a low AL providing evidence that the observed association was independent of early life SEP and other life course factors
Summary
Cyrille Delpierre and Michelle Kelly-Irving these authors have contributed to this work. Health inequalities have been highlighted between socioeconomic groups within populations worldwide [1, 2]. The rate of premature mortality, is found higher among people with more disadvantaged socioeconomic positions (SEP) across countries and at all stages of the lifespan [2,3,4,5,6]. A better understanding of the aetiological pathways through which adverse health outcomes are generated is key to alleviate the effects of social inequalities in health
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