老年癌症幸存者的负荷应激与全因、癌症特异性及心血管疾病死亡率风险：对1999 - 2010年美国国家健康与营养检查调查的分析
Allostatic load and risk of all-cause, cancer-specific, and cardiovascular mortality in older cancer survivors: an analysis of the National Health and Nutrition Examination Survey 1999-2010.
作者信息
Yang Danting, Wheeler Meghann, Karanth Shama D, Aduse-Poku Livingstone, Leeuwenburgh Christiaan, Anton Stephen, Guo Yi, Bian Jiang, Liang Muxuan, Yoon Hyung-Suk, Akinyemiju Tomi, Braithwaite Dejana, Zhang Dongyu
机构信息
Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL.
Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville, FL.
出版信息
Aging Cancer. 2023 Jun;4(2):74-84. doi: 10.1002/aac2.12064. Epub 2023 May 15.
BACKGROUND
Allostatic load has been linked to an increased risk of death in various populations. However, to date, there is no research specifically investigating the effect of allostatic load on mortality in older cancer survivors.
AIMS
To investigate the association between allostatic load (AL) and mortality in older cancer survivors.
METHOD
A total of 1,291 adults aged 60 years or older who survived for ≥1 year since cancer diagnoses were identified from the 1999-2010 National Health and Nutrition Examination Survey. AL was the exposure of interest incorporating 9 clinical measures/biomarkers; one point was added to AL if any of the measures/biomarkers exceeded the normal level. The sum of points was categorized as an ordinal variable to reflect low, moderate, and high AL. Our outcomes of interest were all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality. Death was identified by linkage to the National Death Index. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence intervals (CI) of mortality by AL category.
RESULTS
Overall, 53.6% of participants were male and 78.4% were white. The mean age of study participants at interview was 72.8 years (SD=7.1). A total of 546 participants died during the follow-up (median follow-up time: 8.0 years). Among them, 158 died of cancer and 106 died of cardiovascular events. Results from multivariable Cox proportional hazards models showed that higher ALS was positively associated with higher all-cause mortality (ALS=4-9 vs. ALS =0-1: aHR=1.52, 95% CI =1.17-1.98, p-trend<0.01) and higher cancer-specific mortality (ALS=4-9 vs. ALS =0-1: aHR=1.80, 95% CI =1.12-2.90, p-trend=0.01). The association between ALS and cardiovascular mortality was positive but non-significant (ALS=4-9 vs. ALS =0-1: aHR=1.59, 95% CI =0.86-2.94, p-trend=0.11).
CONCLUSIONS
Our study suggests that older cancer survivors can have a higher risk of death if they have a high burden of AL.
背景
在不同人群中，应激负荷与死亡风险增加有关。然而，迄今为止，尚无专门研究应激负荷对老年癌症幸存者死亡率影响的研究。
目的
探讨老年癌症幸存者的应激负荷（AL）与死亡率之间的关联。
方法
从1999 - 2010年国家健康与营养检查调查中识别出1291名60岁及以上的成年人，他们自癌症诊断后存活≥1年。AL是纳入9项临床指标/生物标志物的研究暴露因素；如果任何一项指标/生物标志物超过正常水平，则给AL加1分。分数总和被分类为一个有序变量，以反映低、中、高应激负荷。我们感兴趣的结局是全因死亡率、癌症特异性死亡率和心血管疾病（CVD）特异性死亡率。通过与国家死亡指数联动来确定死亡情况。使用多变量Cox比例风险模型来估计按AL类别划分的死亡率的调整风险比（aHR）和95%置信区间（CI）。
结果
总体而言，53.6%的参与者为男性，78.4%为白人。研究参与者在访谈时的平均年龄为72.8岁（标准差 = 7.1）。共有546名参与者在随访期间死亡（中位随访时间：8.0年）。其中，158人死于癌症，106人死于心血管事件。多变量Cox比例风险模型的结果显示，较高的应激负荷评分与较高的全因死亡率呈正相关（应激负荷评分 = 4 - 9 vs. 应激负荷评分 = 0 - 1：aHR = 1.52，95% CI = 1.17 - 1.98，p趋势<0.01）以及较高的癌症特异性死亡率（应激负荷评分 = 4 - 9 vs. 应激负荷评分 = 0 - 1：aHR = 1.80，95% CI = 1.12 - 2.90，p趋势 = 0.01）。应激负荷评分与心血管死亡率之间的关联为正，但不显著（应激负荷评分 = 4 - 9 vs. 应激负荷评分 = 0 - 1：aHR = 1.59，95% CI = 0.86 - 2.94，p趋势 = 0.11）。
结论
我们的研究表明，应激负荷负担高的老年癌症幸存者可能有更高的死亡风险。
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