Psychosocial Experience, Cumulative Biological Risks

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Psychosocial Experience, Cumulative Biological
Risks Health Trajectories over the Life Course
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(No Transcript)
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Adaptive Allostasis vs. Allostatic wear tear
Allostatic Load
System Parameter (e.g., BP, Glucose, Cortisol)
Adaptive allostasis
TIME
(Stimulus)
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1988 E.P.E.S.E. INTERVIEW DURHAM, NC NEW HAVEN,
CT EAST BOSTON, MA n4,030 AGED 70 - 79
MACARTHUR SELECTION 1,313 (top 33) selected
based on PHYSICAL FUNCTION CONGNITIVE FUCTION
1988 MACARTHUR INTERVIEW LONGITUDINAL COHORT
n1,189
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Initial Operationalization of Allostatic Load
(top risk quartiles)

• Cardiovascular
• HPA Axis
• Symp. Nerv. Sys
• Metabolism

• Resting Systolic Diastolic BP
• Ur. cortisol (12 hr), DHEA-S
• Ur. NE, EPI (12hr)
• Glycosylated Hemoglobin,
• HDL/total Cholesterol, WHR

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Additions to Operationalization of Allostatic Load

• Inflammation
• Lung Fx
• Renal Fx

• IL-6, CRP, fibrinogen, albumin
• Peak Flow rate
• Creatinine Clearance

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Allostatic Load 7-yr Mortality
p-trend lt0.0001
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Allostatic Load Sub-scales 7-yr Mortality
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Health Consequences of Allostatic Load

• 7-year All Cause Mortality
• Incident CVD
• Change in Physical Performance
• Change in Cognitive Performance

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Alt. Summary Measures of Allostatic Load

• Original Equi-weighted (for each of 10
  parameters)
• Identify scores in top quartile of risk
• Count number of parameters for which subject has
  a score in top quartile.
• Range of Scores
• (0-10)

• Canonical Correlation based scoring (for each
  parameter
• Use raw scores (i.e., full range of scores)
• Weight by canonical weight
• Range of Scores
• (5.2-10.4)

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Canonical weights for 7-yr Change in Physical and
Cognitive Performance
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Original vs. Canonical Correlation-based AL
scores - Correlations with 7-yr decline in
function
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Population Variation in Allostatic Load

• Evidence for cumulative effects over time and
  related to psychosocial factors and life stress?

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NHANES III Age 20
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NHANES III Allostatic Load

• Glycosylated Hemoglobin (high)
• Waist-hip ratio (high)
• Albumin (low)
• C-reactive protein (high)

• Systolic BP (high)
• Diastolic BP (high)
• Pulse Rate
• HDL cholesterol (low)
• Total/HDL cholesterol (high)

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Summary Allostatic Load Component Criterion
Cutpoints
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NHANES III Age-related increases in biological
risks
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NHANES III Age-related increases in biological
risks
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NHANES III Age-related increases in biological
risks
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NHANES III Allostatic load by Age
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Variation by Socio-economic Status?
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Allostatic Load by Education - MacArthur Aging
Study
Educational Attainment
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Coronary Artery Risk Development in young Adults
(CARDIA)

• N 5,000, ages 18-30 in 1985 (ages 33-45 at
  15-yr follow-up in 2000)
• 4 sites (Birmingham, AL Chicago, IL
  Minneapolis, MN Oakland, CA)
• Stratified sampling - equal by gender,
  ethnicity, age and education
• Followups 1987, 1990, 1992, 1995, 2000

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Allostatic Load Variables

• Cardiovascular
• SBP DBP
• Heart Rate Var.
• Low Freq. Power
• High Freq. Power
• SD
• Metabolism
• HDL Cholesterol
• LDL Cholesterol
• Triglycerides
• Fasting Insulin
• Fasting Glucose
• WHR

• Inflammation
• Fibrinogen
• CRP
• SNS
• Ur. Epinephrine
• Ur. Norepinephrine
• HPA
• Sal. Cortisol
• Am rise
• Pm decline

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Metabolic Parameters by Education
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SNS Activity (catecholamines) by Education
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Heart Rate and Salivary Cortisol by Education
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High Risk QuartilesCARDIA vs. MacArthur
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High Risk QuartilesCARDIA vs. MacArthur
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Distribution of AL
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AL Score by Education in Race Groups
Linear trend p lt .07
Linear trend p lt .001



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AL Score by Ethnicity within education groups



p lt .05 p lt .10
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Ethnicity Educational Gradients in Allostatic
Load (scores2) NHANES III
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Crimmins and Wong, 2003
Source NHANES
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Psychosocial factors Allostatic Load
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Social Integration and Allostatic Load
MacArthur Aging Study
High AL (5)
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Social Integration AL CARDIA (ages 33-45)
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Social Support AL CARDIA
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Social Conflict AL CARDIA
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Negative Social Interactions Allostatic Load
MacArthur Aging Study
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Biological Mediation?

• Pathways for psychosocial influences on
  trajectories of aging

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SES (Education) effects on 7-year mortality -
mediation by allostatic load
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Summary I

• Multi-systems view of biological dysregulation
  (allostatic load) may be valuable research
  construct for understanding impact of life
  experience on full range of biological systems
  and consequent health risks
• Cumulative indices of AL predict a range of major
  health risks (mortality, cognitive/phys decline,
  incident/recurrent CVD)
• Multiple biological systems shown to make
  moderate contributions to the overall, cumulative
  risks

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Summary II

• Support for hypothesized contributions of life
  stress to more rapid accumulation of such
  biological risk is provided by evidence that
  population variation in summary indices of
  allostatic load
• is evident by early adulthood
• shows greater variation in levels of accumulation
  with age, and
• appears to be related to various indices of life
  stress (e.g., socio-economic status, social
  integration, social support conflict)

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Summary III

• Preliminary evidence that cumulative biological
  dysregulations represent pathways through which
  psychosocial experiences get inside the body to
  affect risks for disease and disability over the
  life course