Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study

Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. This study examined the association of an MSBR index with cancer mortality. The sample included n = 13,628 adults aged 20–90 from the NHANES III Linked Mortality File (1988–1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HOMA(ir), triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13–2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07–1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05–1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92–1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.