Low Positive Social Determinants of Health Exposure Amplifies the Association between Allostatic Load and Risk of Cardiovascular Mortality in Cancer and Non-Cancer Patients

BackgroundHigh allostatic load (AL) is associated with an increased risk of cardiovascular death (CVD), but little is known about how social determinants moderate this relationship. MethodsWe conducted a retrospective cohort analysis of the National Health and Nutrition Examination Survey years 1999-2010 linked with the National Death Index. We fit age, race, and sex-adjusted Fine & Gray models to calculate sub-distribution hazard ratios (SHR) of CVD among adults exposed to high versus low levels of positive social determinants of health (PSDOH), stratified by high and low AL status. ResultsAmong 22,775 participants, 1,939 (8.5%) had a cancer history. In the full cohort, low PSDOH was associated with 38% increased risk of CVD among high AL adults (SHR: 1.38, 95% CI: 1.22 - 1.56) and 57% increased risk among low AL adults (SHR: 1.57, 95% CI: 1.32 - 1.87). Among adults with no cancer history, low PSDOH was associated with 36% increased risk among high AL adults (SHR: 1.36, 95% CI: 1.19 - 1.55) and 59% increased risk among low AL adults (SHR: 1.59, 95% CI: 1.32 - 1.92). In the cancer cohort, low PSDOH was associated with 77% increased risk among high AL adults (SHR: 1.77, 95% CI: 1.32 - 2.37) and 73% increased risk among low AL adults (SHR: 1.73, 95% CI: 1.02 - 2.94). ConclusionsLow PSDOH amplified the association between AL and CVD in all cohorts, with the highest risk increases among adults with cancer history. This suggests that socioeconomic-related distress supersedes biological changes from AL in relation to CVD.