Lopez-Pentecost Melissa, Li Cynthia, Vernon Marlo, Howard Sydney Paige, Amezcua Jessica, Moore Justin Xavier
Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Soc Sci Med. 2025 Jan;365:117515. doi: 10.1016/j.socscimed.2024.117515. Epub 2024 Nov 16.
Cancer remains the leading cause of death among Hispanics in the US. While social determinants of health, such as educational attainment, have been linked to negative health outcomes, their biological mechanisms remain poorly understood. We evaluated the association between educational attainment and allostatic load (AL), a measure of chronic physiologic stress, with risk of cancer mortality in Hispanic women from the National Health and Nutrition Examination Survey (NHANES).
We performed a retrospective analysis among 5637 Hispanic women in NHANES from 1988 to 2010 with follow-up data through 2019. Educational attainment was categorized into a two-level variable: less than high school education vs high school graduate and above. AL score was calculated as the sum of nine abnormal biomarkers and health measures. Participants were considered to have high AL if their score was three or more. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios of cancer death between educational attainment and AL (adjusted for age, family poverty to income ratio, country of birth, marital status, preferred language, health insurance, current smoker status, congestive heart failure and history of heart attack).
Hispanic women who did not attain high school education and living with high AL had more than a 3-fold increased risk of cancer death when compared to Hispanic women with at least high school education with low AL (unadjusted HR: 3.18, CI: 1.64-6.17). Hispanic women who did not complete high school and had high AL had a nearly two-fold increased risk of cancer mortality (unadjusted HR: 1.96, CI: 1.10-3.49) compared to their low AL counterparts. These effects attenuated after adjustments for age.
Hispanic women with higher AL face elevated cancer mortality risk, with a greater effect observed among women with lower educational levels. Future research among a larger Hispanic sample should explore additional factors such as length of US residence, citizenship status, and country of birth, to better understand their influence on educational attainment, AL, and cancer mortality.
癌症仍是美国西班牙裔人群的主要死因。虽然健康的社会决定因素，如教育程度，已与负面健康结果相关联，但其生物学机制仍知之甚少。我们评估了教育程度与应激负荷（AL）（一种慢性生理应激指标）之间的关联，以及来自国家健康与营养检查调查（NHANES）的西班牙裔女性的癌症死亡风险。
我们对1988年至2010年NHANES中5637名西班牙裔女性进行了回顾性分析，并获取了截至2019年的随访数据。教育程度被分类为一个两级变量：高中以下学历与高中及以上学历。AL评分计算为九个异常生物标志物和健康指标的总和。如果参与者的评分达到或超过三分，则被认为具有高AL。采用加权Cox比例风险模型来估计教育程度和AL之间癌症死亡的调整后风险比（根据年龄、家庭贫困与收入比、出生国家、婚姻状况、首选语言、健康保险、当前吸烟状况、充血性心力衰竭和心脏病发作史进行调整）。
与至少具有高中学历且AL较低的西班牙裔女性相比，未达到高中学历且AL较高的西班牙裔女性的癌症死亡风险增加了三倍多（未调整的风险比：3.18，置信区间：1.64 - 6.17）。与AL较低的女性相比，未完成高中学业且AL较高的西班牙裔女性的癌症死亡率增加了近两倍（未调整的风险比：1.96，置信区间：1.10 - 3.49）。在对年龄进行调整后，这些影响有所减弱。
AL较高的西班牙裔女性面临更高的癌症死亡风险，在教育水平较低的女性中观察到的影响更大。未来在更大的西班牙裔样本中进行的研究应探索其他因素，如在美国的居住时间、公民身份和出生国家，以更好地了解它们对教育程度、AL和癌症死亡率的影响。
