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Cited by 76Health disparities and outcomesChronic Disease Management StrategiesStress Responses and Cortisol

Predicting all-cause and cause-specific mortality by static and dynamic measurements of allostatic load: a 10-year population-based cohort study in Taiwan

Hwang, An-Chun, Peng, Li-Ning, Wen, Yu-Wen, Tsai, Yi-Wen, Chang, Li-Chuan, Chiou, Shu-Ti, Chen, Liang-Kung·2014·Journal of the American Medical Directors Association
DOI 10.1016/j.jamda.2014.02.001
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Abstract

Objective To evaluate the role of allostatic load (AL), either static or dynamic measurements, in predicting all-cause and cause-specific mortality of older people in Taiwan.Design A prospective cohort study.Setting Population-based community study.Participants One thousand twenty-three community-dwelling older people.Measurements Allostatic load (calculated by systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glycosylated hemoglobin, fasting glucose, waist-to-hip ratio, body mass index, dehydroepiandrosterone sulfate, insulin-like growth factor-1, 12-hour urine cortisol, 12-hour urine epinephrine, 12-hour urine norepinephrine, 12-hour urine dopamine, white blood cell count, neutrophils, interleukin-6, albumin, creatinine) and all-cause and cause-specific mortality from national death registry.Intervention None.Results Adjusted for age and sex, each 1-point increase in AL score was associated with 20% incremental risk of mortality [hazard ratio 1.20, 95% confidence interval (CI) 1.09-1.31]. This association can be extended to cause-specific mortality in both sexes in general. In addition, the higher AL score quintile was significantly associated with higher risk of 10-year all-cause mortality (P < .0001). This association was consistent across different cause-specific mortality (ie, malignant neoplasm (P = .008), cardiometabolic diseases (P < .0001), infectious diseases (P < .0001), respiratory diseases (P < .0001), and others (P = .0002), respectively. Compared with AL score decliners, adjusted for age, sex, and baseline AL score in 2000, participants with fast increase had significantly higher mortality (HR 2.68, 95% CI 1.23-5.84, P = .01). The effect was stronger in men (HR 2.83, 95% CI 1.1-7.29, P = .03 in slow increase; HR 4.06, 95% CI 1.56-10.6, P = .001 in fast increase group), but it was insignificant in female participants.Conclusions Higher AL score or rapid increase of AL score significantly increased subsequent mortality risk in older adults, either measured statically or dynamically. AL is predictive of 10-year mortality regardless of cause of death, and rapid increase in AL score is associated with higher subsequent mortality.

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  • There are reliable indices of early damage to regulatory systems, allostatic load, and cellular aging such as inflammation, telomere length, and epigenetic clock that can be measured during mid-life and serve as markers, risk factors, and likely mechanistic precursors to disease or early mortality.

    “Fortunately, although diagnosable disease does not occur until later in life, there are several reliable indices of early damage to regulatory systems, allostatic load (Hwang et al., 2014; Robertson et al., 2017; Seeman et al., 2001), and cellular aging such as inflammation, telomere length, and epigenetic clock (Chen et al., 2016; Codd et al., 2013; Emerging Risk Factors Collaboration et al., 201”

    From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Hwang et al., 2014

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Authors
Hwang, A.-C., Peng, L.-N., Wen, Y.-W., Tsai, Y.-W., Chang, L.-C., Chiou, S.-T., & Chen, L.-K.
Affiliations
  • Taipei Veterans General Hospital (TW)
  • Chang Gung University (TW)
  • National Yang Ming University (TW)
  • Ministry of Health and Welfare (TW)
ORCID
Venue
Journal of the American Medical Directors Association
Publisher
Elsevier BV
Published
2014-07
Volume
15
Issue
7
Pages
490-496
ISSN
1525-8610 (ISSN-L)
DOI
10.1016/j.jamda.2014.02.001
OpenAlex
W2003831016
Cited by
76
References
36
Citations by year
2026: 4 · 2025: 6 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 9 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 5 · 2015: 3 · 2014: 1
FWCI
6.79
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Medical Directors Association (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
allostatic load, all-cause mortality, cause-specific mortality, older adults, mortality prediction, biomarkers, cortisol, catecholamines, inflammatory markers, cardiometabolic disease, infectious disease mortality, respiratory mortality, sex differences, community-dwelling older adults, Taiwan, mortality risk stratification, dehydroepiandrosterone sulfate, insulin-like growth factor I
MeSH terms
Aged, Cause of Death, Female, Homeostasis, Humans, Male, Middle Aged, Predictive Value of Tests, Sex Factors, Taiwan, Cohort Studies, Allostasis

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