Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus.
Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2022 Jul 1;5(7):e2221626. doi: 10.1001/jamanetworkopen.2022.21626.
Adverse social determinants of health (SDHs) (eg, poverty) are associated with poor oncologic outcomes among patients with lung cancer. However, no studies have evaluated biological correlates of adverse SDHs, operationalized as allostatic load (AL), with mortality due to lung cancer.
To examine the association among AL, SDHs, and mortality among patients with metastatic non-small cell lung cancer (NSCLC).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of an observational cohort was performed at a National Cancer Institute-designated comprehensive cancer center with data accrued from June 1, 2017, to August 31, 2019. Patients with metastatic (stage IV) NSCLC enrolled at diagnosis into a prospective observational cohort study were included in the present analysis if they had all the biomarkers to calculate an AL score (N = 143). Follow-up was completed on August 31, 2021, and data were analyzed from July 1 to September 30, 2021.
Social determinants of health.
Overall mortality and AL.
A total of 143 patients met the study criteria with a median age of 63 (IQR, 55-71) years (89 men [62.2%] and 54 women [37.8%]). In terms of race and ethnicity, 1 patient (0.7%) was Asian, 7 (4.9%) were Black, 117 (81.8%) were White, 17 (11.9%) were of multiple races, and 1 (0.7%) was of other race or ethnicity. The mean (SD) AL was 2.90 (1.37). Elevated AL covaried with lower educational level (r = -0.26; P = .002), male sex (r = 0.19; P = .02), limited mobility (r = 0.19; P = .04), worsening self-care (r = 0.30; P < .001), problems engaging in usual activities (r = 0.21; P = .01), depressive symptoms (r = 0.23; P = .005), and a high number of stressful life events (r = 0.30; P < .001). Multivariable analysis found only increasing difficulty with mobility (r = 0.37 [95% CI, 0.13-0.60]; P = .002) and male sex (r = 0.63 [95% CI, 0.19-1.08]; P = .005) associated with higher AL. On adjusted analysis, elevated AL (hazard ratio, 1.43 [95% CI, 1.16-1.79]; P = .001) and low educational level (hazard ratio, 2.11 [95% CI, 1.03-4.34]; P = .04) were associated with worse overall mortality.
The findings of this cross-sectional study suggest that higher AL was associated with adverse SDHs and worse overall mortality among patients with advanced NSCLC. These results provide a framework for replication and further studies of AL as a biological correlate for SDH and future prognostic marker.
不利的社会决定因素健康（SDH）（例如贫困）与肺癌患者的肿瘤不良结局相关。然而，没有研究评估过生物相关性不利的 SDH，即身体应激负担（AL），与肺癌死亡率的关系。
检验 AL、SDH 与转移性非小细胞肺癌（NSCLC）患者死亡率之间的相关性。
设计、地点和参与者：这是一项在国家癌症研究所指定的综合性癌症中心进行的观察性队列研究，数据来自 2017 年 6 月 1 日至 2019 年 8 月 31 日。如果患者在诊断时入组了前瞻性观察性队列研究，且有计算 AL 评分的所有生物标志物（n=143），则将其纳入本分析。随访于 2021 年 8 月 31 日完成，数据分析于 2021 年 7 月 1 日至 9 月 30 日进行。
社会决定因素健康。
总体死亡率和 AL。
共有 143 名患者符合研究标准，中位年龄为 63（IQR，55-71）岁（89 名男性[62.2%]和 54 名女性[37.8%]）。在种族和民族方面，1 名患者（0.7%）为亚洲人，7 名（4.9%）为黑人，117 名（81.8%）为白人，17 名（11.9%）为多种族裔，1 名（0.7%）为其他种族或民族。平均（SD）AL 为 2.90（1.37）。AL 升高与较低的教育水平相关（r=-0.26；P=0.002）、男性（r=0.19；P=0.02）、活动受限（r=0.19；P=0.04）、自我护理能力下降（r=0.30；P<0.001）、日常活动困难（r=0.21；P=0.01）、抑郁症状（r=0.23；P=0.005）和生活压力事件增加（r=0.30；P<0.001）。多变量分析仅发现活动能力下降（r=0.37 [95%CI，0.13-0.60]；P=0.002）和男性（r=0.63 [95%CI，0.19-1.08]；P=0.005）与 AL 升高相关。在调整分析中，AL 升高（危险比，1.43 [95%CI，1.16-1.79]；P=0.001）和教育水平较低（危险比，2.11 [95%CI，1.03-4.34]；P=0.04）与整体死亡率较差相关。
这项横断面研究的结果表明，在晚期 NSCLC 患者中，较高的 AL 与不利的 SDH 和较差的整体死亡率相关。这些结果为 AL 作为 SDH 的生物学相关性和未来预后标志物的复制和进一步研究提供了框架。
