Dr. Justin X. Moore. (credit: MIKE HOLAHAN/AUGUSTA UNIVERSITY)
The team led by Moore performed a retrospective analysis of more than 41,000 people from the US National Health and Nutrition Examination Survey.
By JUDY SIEGEL-ITZKOVICH Published: OCTOBER 6, 2022
Updated: OCTOBER 6, 2022
The wear and tear on the body from chronic and lifelong stress can lead to a significantly higher risk of dying from cancer, according to researchers at the Medical College of Georgia.
That strain and tension, called the allostatic load, refers to the cumulative effects of stress over time.
“As a response to external stressors, your body releases a stress hormone called cortisol,” said Dr. Justin Xavier Moore, an epidemiologist at the college’s Georgia Cancer Center. “Once the stress is over, these levels should go back down.”
“However, if you have chronic, ongoing psychosocial stressors that never allow you to ‘come down,’ then that can cause wear and tear on your body at a biological level,” he added.
The team, led by Moore, performed a retrospective analysis of more than 41,000 people from the US National Health and Nutrition Examination Survey (NHANES), whose data was collected between 1988 and 2019.
The database includes baseline biological measures of participants – body mass index, diastolic and systolic blood pressure, total cholesterol, hemoglobin A1C (higher levels indicate a risk for diabetes), albumin and creatinine (both measures of kidney function) and C-reactive protein (a measure of inflammation) – that the researchers used to determine allostatic load. Those with a score of more than three were categorized as having high allostatic load.
They then cross-referenced those participants with the US National Death Index, maintained by the US National Center for Health Statistics and Centers for Disease Control and Prevention to determine which people died from cancer and when, Moore said.
“To date, there has been limited research on the relationship between allostatic load and cancer among a current, nationally representative sample of US adults,” Moore and his colleagues wrote in the journal SSM Population Health under the title “Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019.”
“Examining the association of allostatic load on cancer outcomes and whether these associations vary by race may give insight to novel approaches in mitigating cancer disparities,” Moore said.
The researchers found that even without adjusting for any potential confounders such as age, social demographics like race and gender, poverty-to-income ratio and educational level, those with a high allostatic load were 2.4 times more likely to die from cancer than those with low allostatic loads.
“But you have to adjust for confounding factors,” Moore said. “We know there are differences in allostatic loads based on age, race and gender.”
Previous research
In previous research, the researchers observed that when looking at trends in allostatic load over 30 years among 50,671 individuals, adults aged 40 and older had greater than a 100% increased risk of high allostatic load when compared with adults under 30.
Regardless of the time period, Black and Latinx adults had an increased risk of high allostatic load when compared with their white counterparts.
Much of that could be attributed to structural racism, things such as difficulty navigating better educational opportunities or fair and equitable home loans, Moore said.
“If you’re born into an environment where your opportunities are much different than your white male counterparts, for example, being a black female, your life course trajectory involves dealing with more adversity,” he suggested,
“If you’re born into an environment where your opportunities are much different than your white male counterparts, for example being a black female, your life course trajectory involves dealing with more adversity.",
Dr. Justin Xavier Moore
Even when controlling for age, the researchers found that people with high allostatic load still have 28% increased risk of dying from cancer.
“That means that if you were to have two people of the same age, if one of those people had high allostatic load, they are 28% more likely to die from cancer,” Moore said.
Adjusting for sociodemographic factors, including sex, race and educational level, high allostatic load led to a 21% increase. Further adjusting the model for other risk factors, including whether participants smoked, previously had a heart attack or previously had been diagnosed with cancer or congestive heart failure, led to a 14% increase.
“The reason race even matters is because there are systemic factors that disproportionately affect people of color,” Moore said. “But even if you take race out, the bottom line is that the environments in which we live, work and play, where you are rewarded for working more and sometimes seen as weak for taking time for yourself, [are] conducive to high stress, which in turn may lead to cancer development and increased morbidity and mortality.”
In the US, cancer is the second leading cause of death after cardiovascular disease and was responsible for an estimated 1.9 million cases and nearly 609,000 deaths in 2021. In Israel, cancer is the No. 1 cause of death, followed by cardiovascular disease.
