The Potential Association Between Allostatic Load and Male Cancer Mortality
A cohort study explores the connection between the two, along with the impact of educational attainment on this relationship.
In the United States, the cancer incidence rate among men is 497 cases per 100,000 members of the population; the highest incidence rate is among non-Hispanic Black males (544 cases per every 100,000 population).1 Lung cancer was considered the leading cause of cancer deaths among men, but the incidence rates for kidney, pancreas, and prostate cancer increased between the 2014 and 2018 timeframe.
The death rates surrounding cancer were the highest among non-Hispanic Black men (178.6 deaths per 100,000 population), while White (157.2 deaths per 100 000 population) and Hispanic represented 157.2 and 109.7 deaths per 100,000 men respectively.
Interestingly enough, social determinants of health—including education, income, and occupation—can reportedly impact cancer discrepancies in men. For example, acquiring a higher level of education can positively benefit one’s health (which was self-reported) in Black men, but the increase is smaller when compared with White men.2 Further, men with less income and educational access are considered to have a greater chance of having a high allostatic load (AL), which measures cumulative physiologic stress on the body over time.
Keeping this in mind, a cohort study published in JAMA Network Open3 sought to determine two factors: whether AL was associated with the cancer risk mortality among males, and if the level of education had an impact on this association.
In data that were analyzed from June to October 2024, the retrospective cohort analysis pulled its information from the National Health and Nutrition Examination Survey—a sample of 5,000 people across the United States, from 1988 to 2010—and was linked with data from the National Death Index, which was available through Dec. 31, 2019. Participating men were 18 years of age and older.
Overall, out of the 20,529 men that were included in the study (mean [SE] age, 41.00 [0.22] years), those with high AL and less than a high school education level had a greater than 4-fold increased risk of cancer mortality (unadjusted HR, 4.71; 95% confidence interval or CI, 3.36-6.60), compared with those with low AL and a college degree or higher.
Further, Black men (HR, 4.19; 95% CI, 2.09-8.40) and White men (HR, 5.77; 95% CI, 4.06-8.20) with a high AL and less than high school educational education reportedly had higher chances for dying due to cancer, compared with those of the same race who had college education and low AL. Following any changes made for age, poverty-to-income ratio, history of cancer, smoking status, and ever congestive heart failure and heart attack, these associations were reduced, but all males (HR, 1.69; 95% CI, 1.15-2.47) and White men (HR, 1.82; 95% CI, 1.16-2.85) presented a greater than 50% increased risk of cancer death, compared with males with a college education and low AL.
“This study found an increased risk of cancer mortality among men with lower educational attainment and high AL,” concluded the study authors. “Education, particularly the completion of HS, plays a crucial role in modifying the association between AL and cancer mortality. To address cancer disparities in the population with low educational achievement, it is essential to prioritize educational attainment and address the underlying social determinants of health. Therefore, it is vital to invest in policies and programs that improve educational access, especially for underserved, minoritized racial and ethnic groups.
“By empowering men with better access to resources that promote health and address chronic and acute life stressors, we can potentially reduce their vulnerability to cancer. When replicating the study, consideration should be given to changes in AL over time, access to healthcare, and other sociodemographic factors. Establishing this causal connection could guide targeted interventions and policies to effectively address disparities, reduce educational gaps, improve health care access, and decrease cancer mortality rates among men with lower educational attainment.”
References
1. Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022;128(24):4251-4284. doi:10.1002/cncr.34479
2. Richardson LJ, Goodwin AN, Hummer RA. Social status differences in allostatic load among young adults in the United States. SSM Popul Health. 2021;15:100771. doi:10.1016/j.ssmph.2021.100771
3. Li C, Howard SP, Rogers CR, et al. Allostatic Load, Educational Attainment, and Risk of Cancer Mortality Among US Men. JAMA Netw Open. 2024;7(12):e2449855. doi:10.1001/jamanetworkopen.2024.49855
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