Duru OK, Harawa NT, Kermah D, Norris KC, et al.
Journal of the National Medical Association. Date of publication 2012 Jan 1;volume 104(1-2):89-95.
1. J Natl Med Assoc. 2012 Jan-Feb;104(1-2):89-95. doi:
10.1016/s0027-9684(15)30120-6.
Allostatic load burden and racial disparities in mortality.
Duru OK(1), Harawa NT, Kermah D, Norris KC.
Author information:
(1)Division of General Infernal Medicine/Health Services Research, University of
California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095, USA.
kduru@mednet.ucla.edu
BACKGROUND: Black-white disparities in mortality persist after adjustment for
socioeconomic status and health behaviors. We examined whether allostatic load,
the physiological profile influenced by repeated or chronic life stressors, is
associated with black-white mortality disparities independent of traditional
sociobehavioral risk factors.
METHODS: We studied 4515 blacks and whites aged 35 to 64 years from the third
National Health and Nutrition Examination Survey (1988-1994), using the linked
mortality file, to ascertain participant deaths through 2006. We estimated
unadjusted sex-specific black-white disparities in
cardiovascular/diabetes-related mortality and noninjury mortality. We
constructed baseline allostatic load scores based on 10 biomarkers and examined
attenuation of mortality disparities in 4 sets of sex-stratified multivariate
models, sequentially adding risk factors: (1) age/clinical conditions, (2)
socioeconomic status (SES) variables, (3) health behaviors, and (4) allostatic
load.
RESULTS: Blacks had higher allostatic load scores than whites; for men, 2.5 vs
2.1, p < .01; and women, 2.6 vs 1.9, p < .01. For
cardiovascular/diabetes-related mortality among women, the magnitude of the
disparity after adjustment for other risk factors (hazard ratio [HR], 1.63; 95%
confidence interval [CI], 0.96-2.75) decreased after adjustment for allostatic
load (HR, 1.15; 95% CI, 0.70-1.88). For noninjury mortality among women, the
magnitude of the disparity after adjustment for other risk factors (HR, 1.43;
95% CI, 1.00-2.04) also decreased after adjustment for allostatic load (HR,
1.26; 95% CI, 0.90-1.78). For men, disparities were attenuated but persisted
after adjustment for allostatic load.
CONCLUSIONS: Allostatic load burden partially explains higher mortality among
blacks, independent of SES and health behaviors. These findings underscore the
importance of chronic physiologic stressors as a negative influence on the
health and lifespan of blacks in the United States.
DOI: 10.1016/s0027-9684(15)30120-6
PMCID: PMC3417124
PMID: 22708252 [Indexed for MEDLINE]
