Understanding the role of age and U.S. acculturation factors on the relationship between allostatic load and cancer mortality risk in Hispanic Americans.

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.

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.

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 < $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 < 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 < 0.01), seeing a mental health provider within past year (% mediated = 9.88, p < 0.05), greater number of healthcare visits within past year (% mediated = 8.31, p < 0.05), and poor self-reported general health condition (% mediated = 14.08, p < 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.

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.

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.

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 article will explore the history and legacy of attempts to advocate for independence in Puerto Rico via the renunciation of United States (US) citizenship. The US acquired Puerto Rico over a century ago, and Puerto Ricans gained US citizenship in 1917, but the island remains an unincorporated territory. Various options, including independence and statehood, have been debated for decades. While voting records show that only a small percentage of the Puerto Rican population supports full independence from the United States, many pro-independence activists spurred debate by renouncing their US citizenship and claiming that they are citizens of Puerto Rico only. This raised questions as to whether they actually became stateless as a result. One of the most notable independence activists, the late Juan Mari Brás, caused confusion at the US State Department, which initially accepted his renunciation of US citizenship only to reverse its decision three years later. A discussion of the multifaceted meaning of ‘citizenship’ in the context of Puerto Rico illuminates the United States’ approach to the international right to a nationality.

Background: Multisystemic biologic risk is a clinically meaningful and practical surrogate for allostatic load, a metric of health risk used to express shared physiologic variance in multiple biologic systems, based on the hypothesis that recurrent exposure to external stressors leads to progressive dysregulation. Allostatic load and proxies capture the complex biologic cascade that occurs in cardiovascular, metabolic, and immune domains in response to chronic environmental and psychosocial stress. Previous research has demonstrated positive associations between higher indices of multisystemic biologic risk and declining cognition, physical function, and increased cardiovascular disease and mortality risk. However, we are not aware of any research testing the association between an index of multisystemic biologic risk and cancer outcomes. Aim: To examine the association of an index of multisystemic biologic risk (MSBRI) with cancer mortality using data from NHANES, and whether the association differed by race/ethnicity and age. Methods: In 8,996 participants in the NHANES III (year 1989-94), age ≥ 40 years with complete data, we created an index of MSBRI using biomarkers from domains of cardiovascular (pulse rate, blood pressure), metabolic (HOMA-IR, triglycerides, waist circumference), and immune (white blood cell count, c-reactive protein, fibrinogen level). Participants were assigned a score for each biomarker informed by clinical cut points, or based upon evidence in the literature indicating a threshold of risk for disease, and each marker within each domain was scored 0 (low), 1 (moderate), and 2 (high); a higher score represents hypothesized higher risk (range 0-14). Cancer mortality was ascertained from linkage to the National Death Index and participants were followed until 2011. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for overall cancer mortality risk with the MSBRI, adjusting for age, sex, education, income, U.S. region, insurance, physical activity, smoking, alcohol, and BMI. All models utilized the appropriate survey weights. Results: There were 621 cancer deaths during follow-up. Non-Hispanic black, Mexican-Americans, and women (overall) had higher average levels of the MSBRI. On a per-unit basis of the MSBRI, the HR (95% CI) for cancer mortality was 1.11 (1.02-1.21) for each unit of increase in score. Additionally, there was evidence that the association may differ by race/ethnicity. Among the non-Hispanic white sample, the per-unit HR (95% CI) for the MSBRI was 1.06 (1.00-1.12), whereas the HR (95% CI) for non-Hispanic Black, Mexican American, and “Other” (all other race ethnicities not including the aforementioned groups) were, respectively, 1.04 (0.95-1.13), 1.07 (0.98-1.18), and 1.23 (1.07-1.42). There was also evidence that the association may differ by age. The HR (95% CI) was 1.09 (0.97-1.24) for participants &amp;gt; 50 years of age, and 1.28 (1.05-1.56) for ages ≤ 50 years. Conclusions: There was strong, positive association between a higher score on an index of multisystemic biologic risk (proxy for allostatic load) and risk for cancer mortality in the NHANES III follow-up cohort. The results also suggest that the association may differ by race/ethnicity and age. These results are some of the first to link a proxy for allostatic load with a major cancer outcome, and because the formulation of the index relied upon common clinical measures, this index may have clinical utility for cancer prediction and thus clinical and population cancer prevention strategies. Citation Format: Teofilia Acheampong, Andrew Odegaard. Multisystemic biologic risk index and cancer mortality: Differences by age group and race/ethnicity [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A54.

The neutrophil percentage-to-albumin ratio (NPAR) had been suggested as a potential prognostic biomarker in various health outcomes. However, its association with mortality in cancer survivors remains unclear. A total of 3,022 cancer survivors from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were linked to mortality outcomes from the National Death Index (NDI). Weighted Cox proportional hazards models was conducted to investigate the association between NPAR and all-cause, cancer and cardiovascular disease (CVD) mortality and the hazard ratio (HR) with 95% confidence interval (CI) were calculated. Restricted cubic spline (RCS) was used to clarify the non-linear association. Additionally, analyses for stratification and sensitivity were performed. During a median follow-up of 75 months, 790 all-cause deaths occurred, including 244 from cancer and 209 from CVD. After adjustment for covariates, higher NPAR was independently associated with increased risk of all-cause mortality (HR = 1.09, 95% CI = 1.06-1.13), cancer mortality (HR = 1.05, 95% CI = 0.99-1.12), and CVD mortality (HR = 1.13, 95% CI = 1.06-1.21). The RCS revealed a U-shaped relationship for all-cause and cancer mortality, with thresholds of 12.76 and 13.60, respectively. Below the threshold, higher NPAR was associated with a reduced risk of mortality (HR = 0.90, 95% CI = 0.82-0.99; HR = 0.87, 95% CI = 0.76-0.99), whereas above the threshold, the risk of mortality increased significantly (HR = 1.14, 95% CI = 1.09-1.18; HR = 1.15, 95% CI = 1.07-1.24). Subgroup and sensitivity analyses confirmed these findings. The U-shaped association with all-cause and cancer mortality, along with the linear association with CVD mortality, underscores the potential of NPAR as a valuable prognostic marker in cancer survivors.

BackgroundThe remnant cholesterol inflammatory index (RCII) is a novel metric that combines remnant cholesterol and high-sensitivity C-reactive protein, reflecting the metabolic and inflammatory risk. This study investigates the association between RCII and long-term risks of all-cause and cause-specific mortality in middle-aged and elderly populations in the US and China.MethodWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS), including 7,565 and 12,932 participants aged 45 years and older, respectively. The participants were categorized into quartiles based on natural log-transformed RCII (lnRCII) values. Kaplan–Meier survival analysis, Cox proportional hazards models, restricted cubic splines (RCS) and mediation analysis were used to examine the relationship between lnRCII and mortality outcomes, adjusting for potential covariates.ResultThe mean age of the participants was 59.90 ± 10.44 years (NHANES) and 58.64 ± 9.78 years (CHARLS), with 53.28% and 52.50% female, respectively. Kaplan–Meier survival analysis showed that higher lnRCII quartiles (≥ 0.79 in NHANES, ≥ -0.13 in CHARLS) were significantly associated with increased all-cause mortality risk (p < 0.001). Each standard deviation (SD) increase in lnRCII corresponded to a higher risk of all-cause mortality, and the hazard ratios (HRs) and 95% confidence interval (CI) were 1.29 (95% CI: 1.21–1.36) in NHANES and 1.26 (95% CI: 1.15–1.38) in CHARLS. In NHANES, lnRCII was also associated with elevated risks of cardiovascular mortality (HR = 1.21, 95% CI: 1.08–1.35) and cancer mortality (HR = 1.30, 95% CI: 1.09–1.55). RCS analysis indicated a J-shaped relationship between lnRCII and both all-cause and cardiovascular mortality, and a linear association with cancer mortality. Mediation analysis showed that systolic blood pressure and fasting plasma glucose partially mediated these associations. Subgroup analyses suggested a stronger association between lnRCII and all-cause mortality in middle-aged US participants (p for interaction = 0.010).ConclusionsElevated RCII levels are significantly associated with increased all-cause mortality risk middle-aged and elderly populations in both the US and China. In the US population, RCII is also associated with increased risks of cardiovascular and cancer mortality. By integrating metabolic and inflammatory risk factors, RCII may serve as a valuable tool for mortality risk stratification and clinical decision-making.

Indications for use of statins are common among patients with nonalcoholic fatty liver disease (NAFLD). Epidemiologic studies have suggested a possible association between statins and decreased risk of malignancies. We hypothesized that statin use has a protective effect on cancer mortality in patients with NAFLD. Participants with NAFLD in 8 rounds of National Health and Nutrition Examination Survey (NHANES) were included in this study. Mortality data were obtained by linking the NHANES data to National Death Index. NAFLD was defined using the previously validated Hepatic Steatosis Index model. A total of 10,821 participants with NAFLD were included and 23% were statin users (n=2523). Statin use was associated with a 43% lower risk of cancer mortality [hazard ratio (HR)=0.57, 95% confidence interval (CI): 0.43-0.75, P<0.001] in multivariable analysis. Statin use under 1 year did not show a significant effect on cancer mortality (HR=0.72, 95% CI: 0.46-1.12), while statin use for 1 to 5 years decreased cancer mortality by 35% (HR=0.65, 95% CI: 0.42-0.99, P=0.46), and statin use >5 years decreased cancer mortality by 56% (HR=0.44, 95% CI: 0.29-0.66, P<0.001). Statin use was associated with a significant decrease in the risk of cancer mortality in NAFLD patients with both low and high risk of liver fibrosis (HR=0.55, 95% CI: 0.38-0.81; and HR=0.53, 95% CI: 0.31-0.89, respectively). Using a large US prospective cohort, we showed statin use is associated with a considerable decrease in cancer-related mortality among patients with NAFLD. These results are important for clinical decision making, as statin indications are prevalent among NAFLD patients, but many do not receive benefit in the event that the statin is discontinued due to liver test abnormalities.

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.

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.

For years, teachers of English as a Second Language (ESL) / United States (US) Citizenship Preparation courses have wondered how they can best prepare immigrants seeking to become United States citizens for a successful naturalization interview? They have desired more knowledge of the actual interview, while most US Citizenship Preparation texts (e.g., Doran de Valdez, Riedel, & Burgos, 1995) focus almost exclusively on US history and government, with minimal reference to the interview itself, an observation corroborated by Nixon & Keenan (1997). Many teachers of US Citizenship courses were aware that despite having memorized facts about US history and government, students were failing their interviews. Course content was clearly not addressing all that would be demanded of them. But the only resource that provided direct information about naturalization interview discourse was testimony from students who had either passed or failed their interviews. Teachers and naturalization applicants alike needed a more accurate description of the specific tasks required.