Association between education and allostatic load with risk of cancer mortality among Hispanic women

Purpose: 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). Methods: 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). Results: Hispanic women who did not attain high school education and living with high AL had more than a 3fold 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. Conclusion: 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.