Correlation between allostatic load index and cumulative mortality: a register-based study of Danish municipalities

OBJECTIVES

The aim of this study was to examine population-based allostatic load (AL) indices as an indicator of community health across 14 municipalities in Denmark.

DESIGN

Register-based study.

SETTING

Data derived from: the Lolland-Falster Health Study, the Copenhagen General Population Study and the Danish General Suburban Population Study. Nine biomarkers (systolic blood pressure, diastolic blood pressure, pulse rate, total serum cholesterol, high-density lipoprotein cholesterol, waist-to-hip ratio, triglycerides, C-reactive protein and serum albumin) were divided into high-risk and low-risk values based on clinically accepted criteria, and the AL index was defined as the average between the nine values. All-cause mortality data were obtained from Statistics Denmark.

PARTICIPANTS

We examined a total of 106 808 individuals aged 40-79 years.

PRIMARY OUTCOME MEASURE

Linear regression models were performed to investigate the association between mean AL index and cumulative mortality risk.

RESULTS

Mean AL index was higher in men (range 2.3-3.3) than in women (range 1.7-2.6). We found AL index to be strongly correlated with the cumulative mortality rate, correlation coefficient of 0.82. A unit increase in mean AL index corresponded to an increase in the cumulative mortality rate of 19% (95% CI 13% to 25%) for men, and 16% (95% CI 8% to 23%) for women but this difference was not statistically significant. The overall mean increase in cumulative mortality rate for both men and women was 17% (95% CI 14% to 20%).

CONCLUSIONS

Our findings indicate the population-based AL index to be a strong indicator of community health, and suggest identification of targets for reducing AL.

Allostatic load as predictor of mortality: a cohort study from Lolland-Falster, Denmark

OBJECTIVES

The purposes of the present study were to determine the association between (1) 10 individual biomarkers and all-cause mortality; and between (2) allostatic load (AL), across three physiological systems (cardiovascular, inflammatory, metabolic) and all-cause mortality.

DESIGN

Prospective cohort study.

SETTING

We used data from the Lolland-Falster Health Study undertaken in Denmark in 2016-2020 and used data on systolic blood pressure (SBP) and diastolic blood pressure (DBP), pulse rate (PR), waist-hip ratio (WHR) and levels of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, glycated haemoglobin A1c (HbA1c), C-reactive protein (CRP) and serum albumin. All biomarkers were divided into quartiles with high-risk values defined as those in the highest (PR, WHR, triglycerides, HbA1c, CRP) or lowest (HDL-c, albumin) quartile, or a combination hereof (LDL-c, SBP, DBP). The 10 biomarkers were combined into a summary measure of AL index. Participants were followed-up for death for an average of 2.6 years.

PARTICIPANTS

We examined a total of 13 725 individuals aged 18+ years.

PRIMARY OUTCOME MEASURE

Cox proportional hazard regression (HR) analysis were performed to examine the association between AL index and mortality in men and women.

RESULTS

All-cause mortality increased with increasing AL index. With low AL index as reference, the HR was 1.33 (95% CI: 0.89 to 1.98) for mid AL, and HR 2.37 (95% CI: 1.58 to 3.54) for high AL.

CONCLUSIONS

Elevated physiological burden measured by mid and high AL index was associated with a steeper increase of mortality than individual biomarkers.