Health Disparities
Prioritizing clinical utility in the association between allostatic load and the consequences of stress Zoe Walts* Zoe Walts Amy Cochran Mark Steinwandel Amy Trentham Dietz Nicci Owusu-Brackett Melissa Rosenkranz Anne Ersig Martha Shrubsole Shaneda Warren Andersen
Introduction: A chronic stress response harms diffuse bodily systems. Disproportionate stress exposure can thus cause downstream racial and socioeconomic cancer outcome disparities. Allostatic load measures the physiological consequences of stress and may identify cancer patients who will benefit from additional services. Currently, clinical use of allostatic load is limited, in part, because biomarkers used to calculate allostatic load are not regularly measured for most patients. We evaluated associations between depression with an established allostatic load index and an abbreviated index composed of a subset of biomarkers readily available in electronic medical records as co-occurring consequences of stress.
Methods: Data arise from a colorectal cancer study within the Southern Community Cohort Study (N=1010); 72% self-identified as Black, 63% reported income <$15,000. Participants completed epidemiologic surveys and provided blood samples which were analyzed for immune, metabolic, and cardiovascular biomarkers. To calculate allostatic load, the number of index biomarkers above standard clinical risk cutoffs were summed. Counts above median indicate high allostatic load. Age adjusted logistic models calculated associations between depression with allostatic load.
Results: Depression was positively associated with high allostatic load using full (OR: 1.64 95%CI: 1.23-2.18) and abbreviated indices (OR: 1.51; 95%CI: 1.16-1.97). Associations were similar in sex-stratified analyses. The association of depression with allostatic load was stronger among white (abbreviated index OR:1.92, 95%CI: 1.11-3.34) than Black (OR:1.37, 95%CI: 1.01-1.87) participants.
Conclusion: Robust relations of depression with allostatic load across indices strengthen its validity as a biomarker of stress-related outcomes. The abbreviated index is a clinically actionable biomarker which may be more easily integrated into patient care to identify high-risk patients and reduce outcome disparities.