PDF(Pubmed)
Abstract：
African American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. Studies suggest that AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined the joint effect of educational attainment and AL status with long-term risk of cancer mortality, and whether education moderated the association between AL and cancer mortality.
We performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status).
AA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24-7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45-2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10-4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer.
Our findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.
We performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status).
AA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24-7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45-2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10-4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer.
Our findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.
摘要：
背景：非裔美国人（AA）女性以多重交叉的边缘化身份驾驭世界。因此，与其他女性相比，AA女性的累积压力负担或同种异体负荷（AL）更高。研究表明，具有大学学位或更高学位的AA女性的AL低于高中文凭的AA女性。我们研究了受教育程度和AL状态与癌症死亡的长期风险的联合影响，以及教育是否缓和了AL和癌症死亡率之间的关联。
方法：我们在1988年至2010年的国家健康和营养检查调查（NHANES）中对4,677名AA女性进行了回顾性分析，随访数据截至2019年12月31日。我们拟合加权Cox比例风险模型，以估计教育程度/AL之间癌症死亡的调整风险比（aHRs）（调整为年龄，收入,和吸烟状况)。
结果：与低AL生活的AA大学毕业生相比，低于高中文凭的AA女性患有高AL的癌症死亡风险（未调整的HR：2.98;95％CCI：1.24-7.15）增加了近3倍。然而,在调整了年龄之后，这种效应减弱(年龄校正HR:1.11;95%CI:0.45-2.74)。与低AL的AA相比，高AL的AA女性癌症死亡风险增加了2.3倍（完全调整后的HR：2.26;95％CI：1.10-4.57）。特别是在具有高中文凭或同等学历且没有癌症史的女性中。
结论：我们的研究结果表明，在受教育程度较低的AA女性中，高的同种异体负荷与较高的癌症死亡率相关。而在受教育程度较高的AA女性中未观察到这种关联。因此，受教育程度在AA女性的同种异体负荷与癌症死亡风险之间的关系中起着调节作用。高等教育可以带来几个好处，包括改善获得医疗保健的机会和提高医疗素养，这反过来可能有助于减轻AL的不利影响和AA女性癌症死亡风险的增加。
方法：我们在1988年至2010年的国家健康和营养检查调查（NHANES）中对4,677名AA女性进行了回顾性分析，随访数据截至2019年12月31日。我们拟合加权Cox比例风险模型，以估计教育程度/AL之间癌症死亡的调整风险比（aHRs）（调整为年龄，收入,和吸烟状况)。
结果：与低AL生活的AA大学毕业生相比，低于高中文凭的AA女性患有高AL的癌症死亡风险（未调整的HR：2.98;95％CCI：1.24-7.15）增加了近3倍。然而,在调整了年龄之后，这种效应减弱(年龄校正HR:1.11;95%CI:0.45-2.74)。与低AL的AA相比，高AL的AA女性癌症死亡风险增加了2.3倍（完全调整后的HR：2.26;95％CI：1.10-4.57）。特别是在具有高中文凭或同等学历且没有癌症史的女性中。
结论：我们的研究结果表明，在受教育程度较低的AA女性中，高的同种异体负荷与较高的癌症死亡率相关。而在受教育程度较高的AA女性中未观察到这种关联。因此，受教育程度在AA女性的同种异体负荷与癌症死亡风险之间的关系中起着调节作用。高等教育可以带来几个好处，包括改善获得医疗保健的机会和提高医疗素养，这反过来可能有助于减轻AL的不利影响和AA女性癌症死亡风险的增加。
