Investigating the Association between Educational Attainment and Allostatic Load with Risk of Cancer Mortality among African American Women

BackgroundAfrican American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. Studies suggest that AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined the joint effect of educational attainment and AL status with long-term risk of cancer mortality, and whether education moderated the association between AL and cancer mortality.MethodsWe performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status).ResultsAA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24–7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45–2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10–4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer.ConclusionsOur findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.

PurposeCancer remains the leading cause of death among Hispanics in the US. While social determinants of health, such as educational attainment, have been linked to negative health outcomes, their biological mechanisms remain poorly understood. We evaluated the association between educational attainment and allostatic load (AL), a measure of chronic physiologic stress, with risk of cancer mortality in Hispanic women from the National Health and Nutrition Examination Survey (NHANES). MethodsWe performed a retrospective analysis among 5,637 Hispanic women in NHANES from 1988 to 2010 with follow-up data through 2019. Educational attainment was categorized into a two-level variable: less than high school education vs high school graduate and above. AL score was calculated as the sum of nine abnormal biomarkers and health measures. Participants were considered to have high AL if their score was three or more. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios of cancer death between educational attainment and AL (adjusted for age, family poverty to income ratio, country of birth, marital status, preferred language, health insurance, current smoker status, congestive heart failure and history of heart attack). ResultsHispanic women who did not attain high school education and living with high AL had more than 3-fold increased risk of cancer death when compared to Hispanic women with at least high school education with low AL (unadjusted HR: 3.18, CI: 1.64 – 6.17). Hispanic women who did not complete high school and had high AL had a nearly two-fold increased risk of cancer mortality (unadjusted HR: 1.96, CI: 1.10–3.49) compared to their low AL counterparts. These effects attenuated after adjustments for age. ConclusionHispanic women with higher AL face elevated cancer mortality risk, with a greater effect observed among women with lower educational levels. Future research among larger Hispanic sample should explore additional factors such as length of US residence, citizenship status, and country of birth, to better understand their influence on educational attainment, AL, and cancer mortality.

Allostatic load (AL) a measure of the cumulative physiological stress occurs when external stressors exceed an individual's ability to adapt, increasing the risk of chronic diseases, including cancer. In the United States (US), Hispanic/Latinx people face acculturation-related stressors like family separation, low socioeconomic status, language barriers, racism, and discrimination, which can elevate AL and cancer risk. This study aims to examine the moderating role of US citizenship status and length of time living in US on the relationship between high allostatic load and risk of cancer mortality among Hispanic/Latinx people. We performed a retrospective analysis using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010 among 7,299 Hispanic/Latinx people linked with National Death Index with follow-up through December 31, 2019. We defined high AL as having more than three abnormal measures among the following nine biomarkers: body mass index, C-reactive protein, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, serum triglycerides, and serum creatinine (above the 75th percentile), or serum albumin (below the 25th percentile). We compared differences in participant characteristics using Rao-Scott Chi-Square tests for weighted survey data. We fit weighted Cox proportional hazards models to estimate hazard ratios and associated 95% confidence intervals of cancer death, stratified by US residence and length of time in US Among 7,299 Hispanic/Latinx people, 2,835 (33.4% weighted) had high AL, and 4,464 (66.6% weighted) had low AL. Hispanic/Latinx people with high AL were more likely to be male, aged 40-59, have a lower level of formal education (52.0% vs. 43.6%, p- value <0.001), and were more often surveyed during the 2007-2010 NHANES period (43.2% vs. 37.2%, p-value <0.001) compared to those with low AL. When considering US residency, participants with high AL were more likely to live in the US longer than 15 years (38.2% vs. 24.8%, p-value <0.001) and be US citizens (65.0% vs. 54.7%, p-value <0.001). Regarding health behaviors, participants with high AL were less likely to have been diagnosed with heart attack and less likely to have any history of smoking. We observed that among Hispanic/Latinx people, those with high AL have a 97% increased risk of dying from any cancer (HR = 1.97, 95% CI = 1.24 - 1.34) when compared to those with low AL. When stratifying by US citizenship status, among Hispanic/Latinx US citizen population those with high AL have a 2.3-times higher risk of cancer death when compared to those with low AL (HR = 2.30, 95% CI = 1.22 - 4.32). Among those who are Hispanic/Latinx non-US citizens, those with high AL have 48% increased risk of cancer death compared to those with low AL, though non-significant (HR = 1.48, 95% CI = 0.64 - 3.43). Our preliminary findings highlight that Hispanic/Latinx people with US citizenship who experience high levels of chronic stress, as measured by AL, have an increased risk of cancer mortality. Citation Format: Jessica Amezcua, Mellisa Lopez-Pentecost, Jessica Y. Islam, Marlo Vernon, Kathleen L. O'Connor, Justin X. Moore. Effect modification of United States residency and length of time in US on the relationship between allostatic load and cancer mortality risk in Hispanic/Latinx Americans: Insights from NHANES (1999-2019) [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B154.

Both baseline cardiorespiratory fitness and adiposity predict the risk of cancer mortality. However, the effects of changes in these two factors over time have not been evaluated thoroughly. The aim of this study was to examine the independent and joint associations of changes in cardiorespiratory fitness and body composition on cancer mortality. The cohort consisted of 13,930 men (initially cancer-free) with two or more medical examinations from 1974 to 2002. Cardiorespiratory fitness was assessed by a maximal treadmill exercise test, and body composition was expressed by body mass index (BMI) and percent body fat. Changes in cardiorespiratory fitness and body composition between the baseline and the last examination were classified into loss, stable, and gain groups. There were 386 deaths from cancer during an average of 12.5 yr of follow-up. After adjusting for possible confounders and BMI, change hazard ratios (95% confidence intervals) of cancer mortality were 0.74 (0.57-0.96) for stable fitness and 0.74 (0.56-0.98) for fitness gain. Inverse dose-response relationships were observed between changes in maximal METs and cancer mortality (P for linear trend = 0.05). Neither BMI change nor percent body fat change was associated with cancer mortality after adjusting for possible confounders and maximal METs change. In the joint analyses, men who became less fit had a higher risk of cancer mortality (P for linear trend = 0.03) compared with those who became more fit, regardless of BMI change levels. Being unfit or losing cardiorespiratory fitness over time was found to predict cancer mortality in men. Improving or maintaining adequate levels of cardiorespiratory fitness appears to be important for decreasing cancer mortality in men.

Health disparities among racial and ethnic minoritized populations, particularly for cancer mortality rates, remain a major public health concern. Men from underrepresented backgrounds (Black and Hispanic men, specifically) face the pervasive effects of discrimination in their daily lives, which also contribute to the complex associations among allostatic load (a marker of chronic stress), educational opportunities, and elevated risks of cancer mortality. To elucidate the associations among educational attainment, allostatic load, and cancer mortality risk among men. This is a retrospective cohort analysis of data from the National Health and Nutrition Examination Survey, a nationally representative sample of approximately 5000 people across the US, from 1988 to 2010 linked with data from the National Death Index, which served as follow-up data for the cohort and was available through December 31, 2019. Participants included men aged 18 years and older. Data were analyzed from June to October 2024. Allostatic load data were stratified by educational attainment levels, categorized as (1) less than high school education and (2) high school graduate and above. Allostatic load score was calculated as the sum of total abnormal biomarkers and health measures (9 total). Participants were considered to have high allostatic load if their score was 3 or more. The primary outcome was cancer death. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios (HRs) of cancer death between educational attainment and allostatic load (adjusted for age, income, and smoking status). Among all 20 529 men (mean [SE] age, 41.00 [0.22] years), those with high AL and less than high school educational attainment had a greater than 4-fold increased risk of cancer mortality (unadjusted HR, 4.71; 95% CI, 3.36-6.60) compared with those with low allostatic load and a college degree or higher. Similarly, both Black men (HR, 4.19; 95% CI, 2.09-8.40) and White men (HR, 5.77; 95% CI, 4.06-8.20) with high allostatic load and less than high school educational attainment had higher risks for cancer death compared with race-specific counterparts with college education and low allostatic load. After adjustments for age, poverty-to-income ratio, smoking status, history of cancer, and ever congestive heart failure and heart attack, the associations were attenuated, but all men (HR, 1.69; 95% CI, 1.15-2.47) and White men (HR, 1.82; 95% CI, 1.16-2.85) still had greater than 50% increased risk of cancer death compared with men with college education and low allostatic load. This study highlights the detrimental association of not attaining a high school degree, combined with high allostatic load as a marker of chronic stress, with cancer mortality. Efforts to promote educational attainment and address the underlying social determinants of health are imperative in reducing cancer disparities in this population.

BackgroundSeveral studies suggest that chronic stress may be associated with increased risk of cancer mortality. Our study sought to determine the association between allostatic load (AL), a measure of cumulative stress, and risk of cancer death; and whether these associations varied by race/ethnicity. MethodsWe performed retrospective analysis using National Health and Nutrition Examination Survey (NHANES) years 1988 through 2010 linked with the National Death Index through December 31, 2019. We fit Fine & Gray Cox proportional hazards models to estimate sub-distribution hazard ratios (SHRs) of cancer death between high and low AL status (models adjusted for age, sociodemographics, and comorbidities). ResultsIn fully adjusted models, high AL was associated with a 14% increased risk of cancer death (adjusted (SHR): 1.14, 95% CI: 1.04–1.26) among all participants and a 18% increased risk of cancer death (SHR:1.18, 95% CI: 1.03–1.34) among Non-Hispanic White (NH-White) adults. When further stratified by age (participants aged <40 years), high AL was associated with a 80% increased risk (SHR: 1.80, 95% CI: 1.35–2.41) among all participants; a 95% increased risk (SHR: 1.95, 95% CI: 1.22–3.12) among NH-White adults; a 2-fold (SHR: 2.06, 95% CI: 1.27–3.34) increased risk among Non-Hispanic Black (NH-Black) adults; and a 36% increased risk among Hispanic adults (SHR: 1.36, 95% CI: 0.70–2.62). ConclusionsOverall, the risk of cancer death was associated with high AL; however, when stratified among NH-Black and Hispanic adults this association was slightly attenuated. ImpactHigh AL is associated with increased risk of overall cancer death, and future studies should delineate the association between AL and cancer-specific mortality to better understand the causal mechanisms between cumulative stress and cancer.

Purpose: Sexual minority (SM) populations (including people who are lesbian, gay, or bisexual) may have higher cancer risk attributable to social determinants of health (SDOH) such as limited healthcare access, discrimination, and a lack of culturally sensitive care. SM people have higher chronic physiological stress, or allostatic load (AL) compared to their heterosexual peers. Furthermore, SM individuals with high AL have more than twice the risk of cancer mortality than heterosexual people with high AL. Here, we examined the mediating effects of SDOH on the relationship of SM identity and AL with cancer mortality risk. Methods: We performed a retrospective analysis of 2001-2010 data from 12,470 participants in the National Health and Nutrition Examination Survey (NHANES) linked to follow-up data from the National Death Index through 12/31/2019. We calculated descriptive statistics across groups defined by SM status and AL (e.g. SM with high AL, SM with low AL, heterosexual with high AL, and heterosexual with low AL) and performed survey-weighted Cox regression to assess the association of sexual orientation/AL with cancer mortality risk. We examined the mediating effects of an individual’s SDOH including household income, self-reported general health condition, whether they attended routine health visits, whether they saw a mental health professional in the past year, location of healthcare visits, poverty to income ratio, self-reported prior health condition, and the number of health visits in the past year. Results: Compared to heterosexual individuals with low AL, SM people with high AL were more likely to report: an annual household income &amp;lt; $20,000 (22.7% vs. 12.8%), living in a single person household (22.5% vs. 8.7%), poor general health condition (7.1% vs. 1.3%), worse health now versus one year ago (16.3% vs. 7.8%), seeing a mental health professional within the past year (21.3% vs. 7.9%), and being in the lowest poverty to income ratio quartile (19.4% vs. 13.9%) (p values &amp;lt; 0.001). Among SM adults with high AL, cancer mortality risk was increased 5-fold (age adjusted HR: 4.89, 95% CI: 2.59 – 9.23) versus heterosexual adults with low AL. Upon additional adjustment for sociodemographic factors (age, race/ethnicity, education status, and gender), the association attenuated but remained significant (adjusted HR: 3.31, 95% CI: 1.77 – 6.16). The following factors all slightly mediated the relationship of SM status and high AL with cancer mortality risk: household income (% mediated = 12.35, p &amp;lt; 0.01), seeing a mental health provider within past year (% mediated = 9.88, p &amp;lt; 0.05), greater number of healthcare visits within past year (% mediated = 8.31, p &amp;lt; 0.05), and poor self-reported general health condition (% mediated = 14.08, p &amp;lt; 0.05). Conclusion: Among a nationally representative sample of more than 12,000 US adults, we observed many SDOH significantly mediate the relationship of SM status and high AL with cancer mortality risk. These results can help inform the identification of intervention points to lessen health disparities. Citation Format: Alisha Patel, Justin X. Moore, Missy Spears, Tracy Casanova, Brent Shelton, Heidi Weiss, Marvin E. Langston, Keith J. Watts, Donte Boyd, Prajakta Adsul, Meredith Duncan. Mediating role of social and health factors on the relationship between sexual minority individuals living with high allostatic load and risk of cancer mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B157.

Background: Several studies suggest that chronic stress may be associated with increased risk of cancer mortality. Our study sought to determine the association between allostatic load (AL), a measure of cumulative stress, and risk of cancer death; and whether these associations varied by race/ethnicity and age. Methods: We performed retrospective analysis using National Health and Nutrition Examination Survey (NHANES) years 1988 through 2010 linked with the National Death Index through December 31, 2015. We fit Fine &amp; Gray Cox proportional hazards models to estimate sub-distribution hazard rates (sHRs) of cancer death between high and low AL status (adjusted for age, sociodemographics, and comorbidities). Results: In fully adjusted models, high AL was associated with a 23% increased risk of cancer death (adjusted (sHR): 1.23, 95% CI: 1.10-1.38) among all participants and a 24% increased risk of cancer death (sHR :1.24, 95% CI: 1.07-1.44) among Non-Hispanic Whites (NH-White). When further stratified by age (participants aged &amp;lt;40 years), high AL was associated with a 74% increased risk (sHR: 1.74, 95% CI: 1.28 – 2.37) among all participants; a 2-fold increased risk (sHR: 2.02, 95% CI: 1.05 – 3.87) among NH-Whites; an 88% (sHR: 1.88, 95% CI: 1.09 – 3.23) increased risk among Non-Hispanic Blacks (NH-Black); and a 48% increased risk among Hispanics (sHR: 1.48, 95% CI: 0.89 – 2.45). Conclusions: Overall, when stratified by race, the risk of death attributed to cancer remained significant, however among NH-Blacks and Hispanics this association was slightly attenuated. Impact: High AL is associated with increased risk of overall cancer death, and future studies should delineate the association between AL and cancer-specific mortality to better understand the causal mechanisms between cumulative stress and cancer. Citation Format: Sydney E. Andrzejak, Justin X. Moore, Malcom Bevel, Samantha R. Jones, Martha S. Tingen. Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2015 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C126.

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

Despite growing recognition of stress-related health inequities, the role of nativity and acculturation in shaping the relationship between chronic stress and cancer outcomes among Hispanic populations remains poorly understood. The purpose of this study was to examine whether nativity factors (United States (US) citizenship status and length of time residing in the US modify the association between allostatic load (AL), a measure of chronic physiologic stress, and cancer mortality among Hispanic adults. We performed a prospective cohort analysis using data from the National Health and Nutrition Examination Survey (NHANES) 1999 - 2010, linked to National Death Index with follow-up through December 31, 2019. Survey-weighted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer mortality, including interaction and age-stratified analyses by US citizenship status, length of time in the US, and country of birth. Fully adjusted models included age, sex, education, year interviewed, smoking status, history of heart attack, and congestive heart failure. Among 7,299 Hispanic adults, 2,835 (33.4% weighted) had high AL. Among Hispanic adults aged ≥ 60years, individuals with US citizenship and low AL (HR = 3.13; 95% CI = 1.37-7.12), as well as those with US citizenship and high AL (HR = 3.32; 95% CI = 1.18-9.35), experienced more than a three-fold increased risk of cancer mortality compared with non-US citizens with low AL. When examining AL by length of time residing in the US among Hispanic adults aged ≥ 60years, those with low AL and more than 10years in the US (HR = 6.32; 95% CI = 1.33-29.90) and those with high AL and more than 10years in the US (HR = 6.34; 95% CI = 1.17-34.43) had approximately a six-fold increased risk of cancer mortality compared with adults with low AL and less than 10years in the US. Cancer mortality risk among Hispanic adults appears to be driven primarily by older age and nativity-related factors rather than AL risk. These findings highlight the need for future research to more fully examine how structural, social, and immigration-related contexts intersect with aging to influence cancer outcomes among Hispanic populations.

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the <scp>DPP</scp>‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

There has been an increasing trend of using noncigarette products, including waterpipe tobacco (WTP), worldwide. While cigarette smoking is a well-established risk factor for numerous cancers, little is known about the association between WTP smoking and cancer mortality. To assess the association between WTP smoking and risk of cancer mortality in Vietnam. This cohort study was based on data from the Hanoi Prospective Cohort Study, an ongoing study with a median (range) follow-up of 11.0 (0.1-11.6) years for participants aged 15 years or older in Northern Vietnam from 2007 through 2019. Data were analyzed from June 1 to September 1, 2023. Tobacco smoking and WTP smoking statuses. Overall and site-specific cancer mortality. Cox proportional regression models were used to calculate the hazard ratio (HR) and 95% CIs for the associations between WTP smoking alone, cigarette smoking alone, and dual WTP and cigarette smoking and the risk of cancer death. A total of 554 cancer deaths were identified among the 39 401 study participants (mean [SD] age, 40.4 [18.8] years; 20 616 females [52.3%]). In multivariable models, compared with never smokers, ever smokers had a significantly increased risk of cancer mortality (HR, 1.87; 95% CI, 1.48-2.35). Exclusive WTP smokers had the highest risk of cancer mortality compared with never smokers (HR, 2.66; 95% CI, 2.07-3.43). Risk of cancer mortality was higher for dual smokers of WTP and cigarettes (HR, 2.06; 95% CI, 1.53-2.76) than for exclusive cigarette smokers (HR, 1.86; 95% CI, 1.41-2.45). As most smokers (95.6% [8897 of 9312]) were male, these patterns were more apparent in male participants. Compared with never smokers, exclusive WTP smoking among males was associated with an elevated risk of death from liver cancer (HR, 3.92; 95% CI, 2.25-6.85), lung cancer (HR, 3.49; 95% CI, 2.08-5.88), nasopharyngeal carcinoma (HR, 2.79; 95% CI, 1.27-6.12), and stomach cancer (HR, 4.11; 95% CI, 2.04-8.27). For exclusive WTP smokers, the risk of cancer mortality was highest among those who smoked 11 to 15 sessions per day (HR, 3.42; 95% CI, 2.03-5.75), started smoking at age 26 to 30 years (HR, 4.01; 95% CI, 2.63-6.11), smoked for 9 to 20 years (HR, 4.04; 95% CI, 2.16-7.56), and smoked 61 to 160 sessions annually (HR, 3.68; 95% CI, 2.38-5.71). For males, the risk of cancer death was lower for those who had quit smoking for more than 10 years, compared with those who quit smoking within 1 year (HR, 0.27; 95% CI, 0.11-0.66; P for trend < .001). In this cohort study in Vietnam, WTP smoking alone or in combination with cigarette smoking was associated with an increased risk of cancer death due to liver cancer, lung cancer, nasopharyngeal carcinoma, and stomach cancer. A tailored program to control WTP smoking is warranted in Vietnam and low- and middle-income countries with a high prevalence of smoking and modest resources to address smoking-related issues.

To investigate the prospective association of irritable bowel syndrome (IBS) with long-term risk of overall, site-specific cancer and cancer-specific mortality in general population. Participants free of inflammatory bowel disease, celiac disease, and any cancer at baseline from the UK Biobank were included, with patients with IBS as the exposure group and non-IBS patients as the reference group. The primary outcome was the incidence of overall cancer and cancer-specific mortality. Secondary outcomes included site-specific cancers and types of digestive cancers. The Cox proportional hazard model was used to investigate the associated risk of incident malignancies and related mortality. Among 449,595 participants, 22,338 (5.0%) were diagnosed with IBS. During a median of 12.2-year follow-up, 2,937 cases of incident cancer were identified in patients with IBS (11.47 per 1,000 person-years), compared with 60,556 cases in reference individuals (12.51 per 1,000 person-years). Of these cases, 512 and 12,282 cancer-specific deaths occurred in IBS and non-IBS groups. Compared with non-IBS, the adjusted hazard ratio for overall cancer and cancer-specific mortality was 0.97 (95% confidence interval: 0.93-1.00, P = 0.062) and 0.83 (0.76-0.91, P < 0.001) among patients with IBS. Specifically, decreased risk of digestive (0.79 [0.71-0.89]), particularly colon (0.75 [0.62-0.90]) and rectal (0.68 [0.49-0.93]), cancers was observed in patients with IBS. Further sensitivity analysis and subgroup analysis by age and sex indicated similar results. Compared with the general population, IBS does not increase the overall risk of cancer. Conversely, IBS is associated with lower risk of incident colorectal cancer and cancer-specific mortality.

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 &amp; 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.

This study aimed to examine the association between chronic pancreatitis (CP) and cancer incidence and mortality among the Korean population. Based on a cancer-free cohort of 8,317,616 individuals between 2002 and 2010, a matched cohort study was conducted, including 10,899 patients with CP, matched for sex and age with 32,697 individuals without CP. The case and control groups were followed up until the date of onset of cancer or death or the end of follow-up date (December 31, 2018). Cox proportional hazards regression was performed to assess the risk of cancer incidence and mortality. Compared to the control group, patients with CP had a higher risk of all cancers with a hazard ratio (HR) of 1.2 [95% confidence interval (CI) 1.1–1.3]. CP was associated with an increased risk of esophageal cancer (HR 3.9, 95% CI 1.8–8.5) and pancreatic cancer (HR 3.9, 95% CI 2.7–5.5) and a decreased risk of colorectal cancer (HR 0.7, 95% CI 0.5–0.9). Regarding cancer mortality, patients with CP had a 1.2-fold risk of all cancer mortality (95% CI 1.1–1.4), compared with the control group. Patients with CP had a higher risk of death from esophageal cancer (HR 3.5, 95% CI 1.5–8.0) and pancreatic cancer (HR 3.3, 95% CI 2.3–4.7) but had a lower risk of death due to stomach cancer (HR 0.4, 95% CI 0.2–0.8). Patients with CP had a higher risk for both incidence and mortality of all cancer types, especially pancreatic and esophageal cancers, compared with the sex- and age-matched control group.