Abstract
Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. This study examined the association of an MSBR index with cancer mortality. The sample included n = 13,628 adults aged 20–90 from the NHANES III Linked Mortality File (1988–1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HOMAir, triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13–2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07–1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05–1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92–1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.
Highlights
Multi-systemic biological risk (MSBR) is a proxy for allostatic load (AL)
We prospectively examined the association between an index of MSBR and cancer mortality utilizing the mortality linked NHANES III study, a representative sample of the U.S from 1988 to 1994
To inform the interpretation of the main index results, we assessed the association between the individual domains and risk for cancer mortality
Summary
Multi-systemic biological risk (MSBR) is a proxy for allostatic load (AL). It is a metric of health risk that captures the complex biological cascade that occurs in autonomic, metabolic, and immune domains in response to chronic environmental and psychosocial stress[1,2,3]. With cancer being the second leading cause of death in the U.S and globally, having shifting underlying contributors to this burden[28,29,30], a prospective analysis examining the association of an index of MSBR with cancer mortality would address a major gap in the literature. It would allow for the ability to triangulate population-level evidence with in vivo and in vitro studies of stress and cancer outcomes[14,31,32]. Median Age (IQR 25–75) Sex (% Female) % Non-Latino White % Non-Latino Black % Mexican American % Other % High school or less % Without health insurance % Within urban area b% Little to no physical activity c% Currently smoking d% Using ≥1 medication aDiet score (HEI) aAlcohol, drinks/week aBMI
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