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Socio‐economic differentials in peripheral biology: Cumulative allostatic load
Open accessAbstract
This chapter focuses on evidence linking socio‐economic status (SES) to “downstream” peripheral biology. Drawing on the concept of allostatic load, we examine evidence linking lower SES with greater cumulative physiological toll on multiple major biological regulatory systems over the life course. We begin by reviewing evidence linking lower SES to poorer trajectories of aging in multiple, individual physiological systems, followed by evidence of the resulting cumulative, overall burdens of physiological dysregulation seen among those of lower SES. The role of cumulative physiological dysregulation in mediating SES gradients in morbidity and mortality is then examined. We conclude with discussion of the question of interactions between SES (and other such environmental factors) and genetic endowment, and their potential consequences for patterns of physiological activity—an area of research that appears poised to contribute significantly to our understanding of how social conditions “get under the skin” to affect health and aging.
Overview
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TL;DR
This chapter reviews evidence that lower socioeconomic status (SES) is linked to greater cumulative physiological dysregulation across major regulatory systems, conceptualized as allostatic load (AL). It argues that cumulative multisystem AL helps explain SES gradients in morbidity and mortality and may serve as an intermediate outcome for evaluating policies to reduce health disparities.
Key findings
- Lower SES is associated with higher AL across the life course; SES gradients in AL emerge as early as the first 5 years of life and persist through childhood, adulthood, and older age.
- In the MacArthur Study of Successful Aging, the total AL index mediated about 35% of the education gradient in mortality, whereas none of its component items or subscales accounted for anything close to this, with most accounting for under 15%.
- The original simple count AL index showed correlations with decline in cognitive and physical function of 0.12 and 0.30, respectively, compared with 0.17 and 0.39 for a canonical AL index (Karlamangla and Seeman, unpublished data).
- NHANES data show SES gradients in AL by education and age; higher SES older adults exhibit AL levels similar to those of lower SES middle-aged adults.
Methods
- Narrative review/chapter synthesizing evidence linking SES to peripheral biology and allostatic load, including conceptual background and empirical literature.
- Draws on cohorts and surveys including the MacArthur Study of Successful Aging (70–79-year-olds), NHANES III (1988–1994), CARDIA, and Whitehall II.
- The initial AL operationalization used 10 biological parameters across HPA, SNS, cardiovascular, and metabolic systems, counting parameters in the top quartile (bottom quartile for HDL cholesterol and DHEA-S); later work added inflammatory markers CRP and IL-6. Main analyses reviewed associations of AL with mortality, cardiovascular disease, cognitive and physical decline, and mediation of SES gradients.
Limitations
- The paper states that AL is multifaceted and difficult to operationalize, with no accepted “gold standard”; debate continues about which systems and aspects to measure and how to summarize them into cumulative indices.
- The paper states that comparative data on scoring methods remain sparse, and more work is needed before “best practice” guidelines can be offered for AL scoring.
- The paper states that the literature on whether AL mediates SES differentials in health outcomes is small, and additional work is needed to clarify how SES contributes to AL accumulation. Evident from the text: this is a narrative review rather than a systematic review or meta-analysis, and it presents no new primary data collection.
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Claims the paper makes
43 Not checked yet · 16 Own interpretation · 6 No basis given · 4 Own result · 1 Partly supported · accuracy not yet measured
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In the paper
“Although SES gradients in accumulated AL narrow in the oldest age group, consistent with the hypothesis that all are susceptible to age-associated increases in AL”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
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“the effects were found to result from the contributions of multiple regulatory systems represented in the index, 164”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
- Not checked yetcites [164] source
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“As shown in Figure 1A, gradients in HgA1c levels are seen even as early as ages 1-5, with those from lower income (lower PIR) households showing higher prevalence of elevated HgA1c levels compared with children from higher income (higher PIR) families”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
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In the paper
“Using this simple count index, analyses of the MacArthur Study data demonstrated that baseline AL was associated with significantly increased risks for a range of major outcomes, including risks for mortality, incident and recurrent cardiovascular disease, cognitive and physical decline.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
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In the paper
“For example, data from the MacArthur Aging Study suggests that the original simple count index captures a majority of the relevant health risk information-e.g., correlations with decline in cognitive and physical function of 0.12 and 0.30, respectively, for the count index as compared with correlations of 0.17 and 0.39 based on the canonical AL index (Karlamangla and Seeman, unpublished data).”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
- Not checked yetcites Karlamangla and Seeman, unpublished data
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In the paper
“Figure 1B documents that these gradients continue throughout adulthood as well.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
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In the paper
“it is important to note that higher SES older adults exhibit levels of AL that are similar to levels experienced in lower SES adults during middle-age.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“showing that a more comprehensive assessment of biological risks associated with SES (i.e., our index of AL) does the best job of explaining observed SES gradients in mortality risk.85”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
- Not checked yetcites [85] source
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In the paper
“Elevated HPA and cardiovascular parameters have also been linked to poor cognitive functioning in many studies.29,31,[49][50][51][52][53][54]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although lower SES is nearly always associated with poorer trajectories of physiological aging when individual biological parameters are examined, the gradients are generally relatively modest while larger gradients are frequently evident when examining”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Introduction
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- The authors state this as an assumption: Excessive fluctuations in physiologic activity in extent, duration, or frequency can result in wear and tear on the body's regulatory systems.
- The authors state this as an assumption: Relatively modest dysregulation when cumulated across multiple systems may have significant impacts on health risks, even if none of the individual effects would be deemed statistically or clinically significant.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although lower SES is nearly always associated with poorer trajectories of physiological aging when individual biological parameters are examined, the gradients are generally relatively modest while larger gradients are frequently evident when examining”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Introduction
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although lower SES is nearly always associated with poorer trajectories of physiological aging when individual biological parameters are examined, the gradients are generally relatively modest while larger gradients are frequently evident when examining”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Introduction
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In the paper
“For example, dysregulation of metabolism as in Type 2 diabetes has deleterious effects on the brain.49”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
- Not checked yetcites [49] source
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In the paper
“It is important to note that even modest elevations in these biomarkers are associated with adverse outcomes, even when they do not meet accepted thresholds for clinical intervention.21,22”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
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In the paper
“As reviewed in McEwen and Gianaros chapter, these peripheral processes also have feedback loops to the brain such that downstream physiological activity frequently has significant impacts on”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although lower SES is nearly always associated with poorer trajectories of physiological aging when individual biological parameters are examined, the gradients are generally relatively modest while larger gradients are frequently evident when examining”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Introduction
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Indeed, a large body of evidence documents SES gradients for nearly all major peripheral biological parameters, including those reflecting HPA axis regulation, 60,62,66,70,72,[81][82][83][84][85] SNS activity, 60,71,72,81,83,85 heart rate variability (an index of autonomic balance), 60,[86][87][88] resting blood pressure, 61,66,69,83,89- and reaction to challenge (see Ref. 93 for review), lipids/m”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
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In the paper
“as well as evidence supporting the hypothesis that the added stresses and resource constraints associated with lower SES are associated with faster accumulation of AL (i.e., greater age-specific burdens of AL).”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [183] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Building on this initial evidence, Singer and Ryff 184 demonstrated that both adult and childhood SES contributed to observed differences in AL for adults in their early 1960s.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [184] source
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In the paper
“It also acknowledges that few homeostatic networks are solely under local regulation but rather are importantly regulated centrally by the brain (see also McEwen and Gianaros chapter).”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
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In the paper
“As such, our perceptions and cognitive-emotional responses to environmental stimuli can, and do, influence patterns of physiological activity and reactivity as, for example, when our blood pressure rises in anticipation of standing.114”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [114]
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“providing support for the cumulative nature of the risks reflected in such a summary index of AL.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
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In the paper
“Available comparative data suggest that more complex scoring systems that incorporate greater information are, as expected, more strongly related to outcomes.166”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
- Not checked yetcites [166] source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Much of the earliest work presented evidence for these SES gradients in adults 12,57 but more recent work has shown that these same SES gradients are evident as early as the first 5 years of life, [58][59][60] as well as throughout childhood, 59,[61][62][63][64][65] early adolescence, [66][67][68] and into early adulthood.[69][70][71][72][73]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Though suggestive, such comparative data remains sparse and the question of how best to approach cumulative scoring of AL remains a topic of significant interest and discussion.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
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In the paper
“Empirical research has also provided evidence of the cumulative nature of AL across the life-course 183”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [183] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Subsequent work has shown that these associations are repli-cated when a variety of alternative scoring methods that incorporate more complex and detailed scoring algorithms are used to create indices of AL, including canonical correlation analyses, 169 grade-ofmembership 166,167,182 and recursive partitioning.168”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the “gains” in predictive ability appear to be relatively modest.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
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In the paper
“These latter cumulative scores-like their analogs in the childhood psychosocial risk literature-have been shown to predict outcomes better than their individual components.179”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
- Not checked yetcites [179] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“For example, sense of control is more strongly associated with better health among those of lower SES 194”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
- Not checked yetcites [194] source
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In the paper
“Adverse early childhood conditions have also been shown to exacerbate the genetic liability of a polymorphism in the 5-HTT serotonin transporter gene, resulting in heightened risks for depression.133,198”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
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In the paper
“while presence of supportive social ties was strongly related to more positive reports of psychological well-being in lower SES groups.195”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
- Not checked yetcites [195]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As the data reviewed above clearly highlight, SES gets under the skin in multiple inter-related ways as a function of its multiple influences on our brain's cognitive-emotional processes and their related peripheral biological consequences.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
boosteddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Significantly, these interactions appear to be a persistent feature across the life-course.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Current evidence, for example, suggests that lower SES may synergize with other stressors, potentiating the negative impact of “stressors” on accumulation of AL. 67,83,192,193”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is the cumulative total of these biological effects that likely accounts for the broad and consistent gradients seen for SES with multiple health outcomes.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Preliminary evidence also suggests that links between SES and AL are at least partially explained by SES-related gradients in factors such as health behaviors 85”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [85] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Several published reports provide evidence supporting the role of multiple biological systems in mediating SES differentials in mortality.12,57,85,174”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 23
- The quote only partly states this claim. 1
- Probably not a substantial claim. 13
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In the paper
“Moreover, each mediator involved in allostasis is part of a nonlinear network in which each mediator has biphasic effects on physiological outcomes and also has reciprocal regulatory influences on other mediators.115”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Partly supportedcites [115] sourceExperimental — accuracy not yet measured
In “Protection and damage as the two sides of the response to stressors” (page unavailable), the paper describes a nonlinear network in which mediators regulate one another reciprocally. It says this regulation is *sometimes* biphasic; it does not say that each mediator has biphasic effects on physiological outcomes. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Partly supported
None of the sources cited for this claim have been checked yet.
In the paper
“As shown in Figure 2, similar SES gradients are seen for a wide array of additional biological risk factors, including blood pressure, total and HDL cholesterol, and C-reactive protein (CRP) with lower SES associated with a higher prevalence of”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 3 illustrates both of these trends, showing SES gradients in each of three adult age groupings as well as the greater cumulative AL among those of lower SES within each of these age groups.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These associations were found both with respect to an initial 2.5 year follow-up period 176 as well as a longer 7-year period, 164”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Analyses from the MacArthur Study of Successful Aging, for example, document that the total AL index mediates some 35% of the education gradient in mortality while none of its component items or subscales accounts for anything close to this, with most accounting for under 15%.85”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [85] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although lower SES is nearly always associated with poorer trajectories of physiological aging when individual biological parameters are examined, the gradients are generally relatively modest while larger gradients are frequently evident when examining”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Introduction
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Exposure to chronically elevated inflammation processes has also been increasingly recognized as a significant health risk with links to increased risks for osteoporosis, 38,39 cardiovascular disease, [40][41][42][43][44][45] and cognitive decline.[46][47][48]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The negative health consequences of high blood pressure (particularly systolic) have been recognized for decades, including higher death rates, the onset of cardiovascular disease, and the loss of both physical and cognitive functioning.[6][7][8][9]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Similarly, more chronic elevations in SNS activity can raise blood pressure and heart rate that promotes atherosclerosis, and appears to be independently associated with cancer mortality.37”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
- Not checked yetcites [37] source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Several studies have also found that high resting heart rate is associated with increased mortality risk (see Ref. 10 for review).”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
- Not checked yetcites [10] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Elevated glucose levelsas indexed by fasting glucose or more integrated assessments of glucose metabolism such as glycosylated hemoglobin (HgA1c)-have also been related to heart disease risk; 15 to higher mortality; 16 and to poorer cognitive [17][18][19][20] and physical function.8”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Metabolic parameters, including higher total serum and LDL cholesterol, lower HDL cholesterol, and higher relative weight, are also recognized risk factors for poor health outcomes including mortality, cardiovascular disease, and functioning loss.7,[11][12][13][14]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Specifically, the capacity of our brains to imagine scenarios (e.g., potential outcomes of situations) contributes a special feature to human stress responses, so that in the extreme case, one could experience prolonged stress responses solely due to perceptions/beliefs regardless of the actual, objective presence of danger or stressors.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“A growing body of evidence documents consistent SES gradients for nearly all of these biological risk parameters-with lower SES groups exhibiting higher levels of risk.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Accumulating evidence also indicates that inflammatory processes in the body are associated with reductions in volume of a key brain structure, the hippocampus 55 as well as poor sleep 56”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Socioeconomic status gradients in patterns of activity in major regulatory systems
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Indeed, use of such cumulative assessment is now recommended for clinical decision-making related cardiovascular disease risk management.80,180”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Empirical efforts to operationalize allostatic load
What the sources say
- Not checked yetcites [80] source
- Not checked yetcites [180]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Consistent with the hypothesis that lower SES is associated with faster accumulation of AL (i.e., greater “wear-and-tear” on physiological regulatory systems), SES related gradients emerge as early as the first 5 years of life and persist throughout childhood, adulthood, and older age.58,83,85,[185][186][187]”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites 58,83,85,[185][186][187]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Conversely, some individuals may respond only minimally if at all to what most would view as major life challenges.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Analyses of nationally representative U.S. data for adults aged 20 and over from the National Health & Nutrition Survey (NHANES) have also documented these same SES gradients in AL [188][189][190] and the faster age-specific accumulation associated with poverty.191”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [188][189][190]
- Not checked yetcites [191] source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Though supported by less empirical evidence, additional factors likely to influence the frequency of reactivity include: (1) environmental exposures (e.g., neighborhoods where you live and work);”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Indeed, such individual differences in the interpretation of situations can result in dramatically different patterns of response at all levels (cognitive/emotional, behavioral, and physiological).”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Factors that may influence characteristic patterns of reactivity (i.e., maximum change from basal levels and duration of the response) include such things as (1) age (e.g., prolonged neuroendocrine responses at older ages have been found in some studies 124,128 though not all (see Epel et al., 2007 129 for review), as well as decreased vagal tone at rest, 130 decreased cardiovagal baroreflex”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [124]
- Not checked yetcites [128] source
- Not checked yetcites [129]
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“evidence to date clearly points to the value of finding ways to evaluate the multiple, cumulative impacts of SES on our physiology if we are to gain a true understanding of how the consistent and persistent SES gradients in nearly all health outcomes come to be”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consistent with the basic concept of AL (focusing on the known co-occurrence of biological risks), examination of specific biological parameters or regulatory systems/processes provides more modest evidence of mediation, with the most extensive/complete mediation seen when the broadest array of biological systems are taken into account.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Adverse early childhood conditions, for example, have been found to increase the genetic contribution to patterns of morning cortisol rise 196 as well as cortisol reactivity to an unfamiliar situation 197 with MZ twins showing increased concordance as compared with DZ twins.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
- Not checked yetcites [196]
- Not checked yetcites [197] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, shift work 201 and short-turn around time for air crews on trans-meridianal flights 202 have health and cognitive effects that could be ameliorated by work policies.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Policy
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Among those reporting changes in SES, increases in SES from childhood to adulthood were associated with levels of AL closer to the “consistently high SES” group while downward mobility was associated with levels closer to the “consistently low SES” group.184”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > SES gradients in cumulative biological "wear and tear" (that is, allostatic load)
What the sources say
- Not checked yetcites [184] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence linking lower SES conditions to greater/faster cumulative dysregulation in nearly all major biological systems provides clear evidence of the health toll such socio-economic conditions exact.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Policy
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Peripheral biological parameters represent a potentially valuable category of such “intermediate” or short-term outcomes.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Policy
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
- Rests on an assumption: Peripheral biological parameters have shorter time horizons than downstream disease outcomes in terms of responsiveness to changing conditions.
- Rests on an assumption: Peripheral biological parameters are known risk factors for major disease outcomes.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With their likely shorter time horizon, peripheral biological profiles would appear to be good candidates for such shorter-term evaluations-providing early evidence of the impact of a program or policy on risk profiles that are known to predict longer-term disease risks.”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Policy
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Peripheral biological parameters have shorter time horizons than downstream disease outcomes in terms of responsiveness to changing conditions.
- Rests on an assumption: Peripheral biological parameters are known risk factors for major disease outcomes.
In the paper
“To date, a small but growing body of evidence points to significant interactions between genetic endowment and environmental conditions, with different genetic profiles rendering individuals more or less responsive to environmental conditions.134”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
What the sources say
- Not checked yetcites [134]
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Poorer childhood conditions have also been associated with differences in neural responses to negative emotional stimuli 199 as well as differences in physiological reactivity to challenge in college-aged students.84”
§ The Biology of Disadvantage Socio-economic differentials in peripheral biology: Cumulative allostatic load > Future directions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The authors state this as an assumption.
Excessive fluctuations in physiologic activity in extent, duration, or frequency can result in wear and tear on the body's regulatory systems.
“The premise is that while relatively short-term fluctuations in levels of physiologic activity are necessary for the body to respond successfully to stimuli (e.g., the fight or flight response in the face of various types of danger), excessive fluctuations either in terms of the extent, duration or frequency (e.g., responding to perceived”
The authors state this as an assumption.
Allostatic load develops over the life course, with individuals accumulating allostatic load at different rates.
“As a cumulative phenomenon, allostatic load is postulated to develop over the life course, with individuals accumulating AL at different rates.”
The authors state this as an assumption.
The initiation and progression of allostatic load dysregulation is driven by individual differences in the frequency of exposure to real and perceived challenges and differences in patterns of physiological responses to these challenges.
“Both the initiation and progression of such dysregulation is postulated to be driven by individual differences in the frequency of exposure to real and perceived challenges and differences in their patterns of physiological responses to these challenges.”
The authors state this as an assumption.
Population differences in allostatic load develop over time as a result of individual differences in exposure to different situations and stimuli and individual differences in cognitive/emotional reactions to these stimuli.
“Over time, as a result of individual differences in exposure to different situations and stimuli, and individual differences in cognitive/emotional reactions to these stimuli, population differences in allostatic load are postulated to develop.”
The paper relies on this without support.
Older individuals generally have more cumulative allostatic load; within any given age group, there is a range of allostatic loads reflecting differences in prior exposures and reactions to life-time experiences.
“Older individuals will generally have more cumulative load; but within any given age group, there will be a range of allostatic loads that reflect differences in prior exposures and reactions to one's life-time experiences.”
The authors state this as an assumption.
Relatively modest dysregulation when cumulated across multiple systems may have significant impacts on health risks, even if none of the individual effects would be deemed statistically or clinically significant.
“This view of biological risk proposes that relatively modest dysregulation (e.g., somewhat elevated BP and/or more frequent or prolonged elevations in response to stimuli) when cumulated across multiple systems may have significant impacts on health risks, even if none of the individual effects would be deemed either statistically or clinically”
The paper relies on this without support.
Peripheral biological parameters have shorter time horizons than downstream disease outcomes in terms of responsiveness to changing conditions.
“Because such parameters are known risk factors for major disease outcomes but have shorter time horizons than do more downstream disease outcomes in terms of their responsiveness to changing conditions”
The paper relies on this without support.
Peripheral biological parameters are known risk factors for major disease outcomes.
“such parameters are known risk factors for major disease outcomes”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Theoretically, stressful experiences directly increase allostatic load”
From Allostatic load and biological anthropology (2017) · cites this paper as Seeman et al., 2010
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A key mechanism for explaining this association is chronic stress, which is believed to degrade physiological functioning (3)(4)(5)(6)”
From Social disadvantage, genetic sensitivity, and children's telomere length (2014) · cites this paper as [5]
Citations
Cites
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011
Chobanian, A. V. (2003) · JAMA · doi:10.1001/jama.289.19.2560 · Cited by 25,386
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., et al. (2003) · Hypertension · doi:10.1161/01.hyp.0000107251.49515.c2 · Cited by 13,271
Role of Insulin Resistance in Human Disease
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Prediction of coronary heart disease using risk factor categories
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Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., McClay, J., Mill, J., Martin, J., Braithwaite, A., et al. (2003) · Science · doi:10.1126/science.1083968 · Cited by 8,120
Selye, H. (1956) · Medical Entomology and Zoology · Cited by 5,224
Banting lecture 1988. Role of insulin resistance in human disease.
Reaven, G. (1988) · Diabetes · doi:10.2337/diabetes.37.12.1595 · Cited by 3,801
Danesh, J., Wheeler, J. G., Hirschfield, G. M., Eda, S., Eiriksdottir, G., Rumley, A., Lowe, G. D. O., Pepys, M. B., & Gudnason, V. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa032804 · Cited by 2,953
Research works printed but not linked: 4
- Seeman T., 2007, Social determinants of health inequalities: drivers of cumulative risks and biological consequences
- Bernard C., 1878, Les Phenomenes de la vie
- Epel E., 2007, Handbook of health psychology of aging, 119
- Seeman T., In press. Modeling multi‐system biological risk in young adults: coronary artery risk development in young adults study (CARDIA), Am. J. Hum. Biol.
Cited by
Sorted by citations
The social determinants of health: It’s time to consider the causes of the causes
Braveman, P., & Gottlieb, L. (2014) · Public Health Reports® · doi:10.1177/00333549141291s206 · Cited by 3,861
The Social Determinants of Health: Coming of Age
Braveman, P., Egerter, S., & Williams, D. R. (2011) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031210-101218 · Cited by 2,476
Adverse childhood experiences, allostasis, allostatic load and age-related disease
Danese, A., & McEwen, B. S. (2012) · Physiology & Behavior · doi:10.1016/j.physbeh.2011.08.019 · Cited by 2,140
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Self-citation
Metadata
- Authors
- Seeman, T., Epel, E., Gruenewald, T., Karlamangla, A., & McEwen, B. S.
- Affiliations
- University of California, Los Angeles (US)
- University of California, San Francisco (US)
- Rockefeller University (US)
- Corresponding author
- Seeman, Teresa
- Venue
- Annals of the New York Academy of Sciences
- Publisher
- Wiley
- Published
- 2010-02
- Volume
- 1186
- Issue
- 1
- Pages
- 223-239
- ISSN
- 0077-8923 (ISSN-L)
- 1749-6632
- OpenAlex
- W1619226291
- Cited by
- 579
- References
- 219
- Citations by year
- 2026: 17 · 2025: 15 · 2024: 24 · 2023: 32 · 2022: 33 · 2021: 44 · 2020: 38 · 2019: 56 · 2018: 50 · 2017: 39 · 2016: 39 · 2015: 34 · 2014: 46 · 2013: 33 · 2012: 40
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of the New York Academy of Sciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- socioeconomic status, allostatic load, physiological dysregulation, aging trajectories, life course, health disparities, morbidity and mortality, gene-environment interaction
- MeSH terms
- Adaptation, Physiological, Health Status, Humans, Social Class, Social Environment, Socioeconomic Factors, Allostasis
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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