Association of Allostatic Load with All-Cause andCancer Mortality by Race and Body Mass Index in theREGARDS Cohort.

Among 29,701 Black and White participants aged 45 years and older in the Reasons forGeographic and Racial Difference in Stroke (REGARDS) study, allostatic load (AL) was defined asthe sum score of established baseline risk-associated biomarkers for which participants exceeded aset cutoff point. Cox proportional hazard regression was utilized to determine the association of ALscore with all-cause and cancer-specific mortality, with analyses stratified by body-mass index, agegroup, and race. At baseline, Blacks had a higher AL score compared with Whites (Black mean ALscore: 2.42, SD: 1.50; White mean AL score: 1.99, SD: 1.39; < 0.001). Over the follow-up period,there were 4622 all-cause and 1237 cancer-specific deaths observed. Every unit increase in baselineAL score was associated with a 24% higher risk of all-cause (HR: 1.24, 95% CI: 1.22, 1.27) and a 7%higher risk of cancer-specific mortality (HR: 1.07, 95% CI: 1.03, 1.12). The association of AL withoverall- and cancer-specific mortality was similar among Blacks and Whites and across age-groups,however the risk of cancer-specific mortality was higher among normal BMI than overweight orobese participants. In conclusion, a higher baseline AL score was associated with increased risk ofall-cause and cancer-specific mortality among both Black and White participants. Targetedinterventions to patient groups with higher AL scores, regardless of race, may be beneficial as astrategy to reduce all-cause and cancer-specific mortality.