Lifelong stress may increase risk for cancer mortality

Higher allostatic load, a measure of lifelong stress, correlated with increased risk for cancer mortality, especially among younger populations, according to study results published in SSM Population Health.

The findings showed associations of high allostatic load with a 106% increased risk for cancer-associated death among young Black individuals and 95% increased risk among young white individuals.

Background and methods

“Chronic stress causes systemic inflammation. Thus, understanding if stress can have a long-term effect on cancer death was our focus,” Justin Xavier Moore, PhD, epidemiologist and assistant professor in the department of medicine at Medical College of Georgia at Augusta University, told Healio. “In addition, we know that racial and ethnic minorities, women, sexual and gender minorities, and other minority groups experience social and environmental stressors rooted from systemic racism, sexism, misogyny and other biases that give them higher relative allostatic load compared with their white male counterparts.”

For this reason, Moore and colleagues sought to identify possible associations of allostatic load, or cumulative stress, with cancer-associated death and whether such associations varied by race or ethnicity.

The retrospective analysis included data of 41,218 individuals included in the National Health and Nutrition Examination Survey between 1988 and 2019.

Researchers used Fine and Gray Cox proportional hazards models adjusted for age, sociodemographics and comorbidities to estimate subdistribution HRs (sHRs) of cancer death between high and low allostatic load status.


Compared with patients with low allostatic load (n = 21,504), patients with high allostatic load (n = 19,714) appeared more likely to be older (mean age, 53.2 years vs. 39.4 years), identify as Black (12.9% vs. 8.4%), have a higher mean BMI (30.7 kg/m² vs. 25.5 kg/m²), have been diagnosed with congestive heart failure (3.9% vs. 0.8%) or heart attack (5.6% vs. 1.7%), and have any history of cancer (11.3% vs. 5.7%).

Overall, patients with high allostatic load had a 14% increased risk for cancer-associated death (sHR = 1.14; 95% CI, 1.04-1.26). Results additionally showed an 18% increased risk among white individuals (sHR = 1.18; 95% CI, 1.03-1.34) and nonsignificant associations of 8% increased risk among Black individuals and 3% among Hispanic individuals.

“When focusing only on Black patients aged younger than 40 years, those with high allostatic load had a 106% increased risk for death due to cancer,” Moore said. “This result was also similar among young white patients with a high allostatic load, who had a 95% increased risk for death due to cancer.”

Hispanic adults in this age category had a 36% increased risk, results showed.


Researchers and clinicians should consider novel approaches using multilevel strategies that reduce chronic stress and inflammation, such as concerted efforts toward destigmatizing mental health and providing culturally sensitive, competent and affordable resources in primary and preventive care, Moore said.

“A better understanding about allostatic load and cancer-specific etiology is also needed,” he added. “Moreover, cancer is not just one disease but many; thus, understanding how cumulative stress increases risks for varying types of cancer death needs further investigation.

“We only measured allostatic load from available biomarkers and anthropometric measures, including albumin, BMI, C-reactive protein, creatinine, glycohemoglobin, systolic and diastolic blood pressure, total cholesterol and triglycerides, at baseline,” Moore said. “Therefore, studies that examine how allostatic load changes over time in relation to cancer risk could illuminate more information about our findings. Lastly, we examined cancer mortality, and studies will need to examine allostatic load and cancer incidence.”

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