Abstract
Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics’ lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988–1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load’s biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.
Highlights
In the United States (U.S.), there has been an increase in all-cause mortality rates between 2016 and 2017.[1, 2] These estimates vary by race/ethnicity: When compared to non-Hispanic whites, non-Hispanic blacks exhibited higher mortality rates whereas Hispanics had lower rates after adjusting for age.[1, 3] these rates were lower for women than men regardless of race/ ethnicity.[1]
Using data from the National Health and Nutrition Examination Survey (NHANES) III linked to the 2015 mortality file, we examine whether allostatic load, using a cumulative biological risk index,[12, 21] is associated with all-cause and cardiovascular (CVD)-specific mortality risks in U.S adults 25 years of age or older; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups
High allostatic scores were associated with older age, being black or Mexican American, widowed, less educated and low income (Table 2)
Summary
In the United States (U.S.), there has been an increase in all-cause mortality rates between 2016 and 2017 (age-adjusted rates: 728.8/100,000 and 731.9/100,000, respectively).[1, 2] These estimates vary by race/ethnicity: When compared to non-Hispanic whites, non-Hispanic blacks exhibited higher mortality rates whereas Hispanics had lower rates after adjusting for age.[1, 3] these rates were lower for women than men regardless of race/ ethnicity.[1]. While age-adjusted mortality rates for cause-specific mortality in the U.S are not available according to race/ethnicity,[1, 7] heart disease mortality has decreased since 2000 (256.6/100,000 in 2000; 179.1/100,000 in 2010; and 165.0/ 100,000 in 2017).[2]
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