Understanding the role of age and U.S. acculturation factors on the relationship between allostatic load and cancer mortality risk in Hispanic Americans

PURPOSE: Despite growing recognition of stress-related health inequities, the role of nativity and acculturation in shaping the relationship between chronic stress and cancer outcomes among Hispanic populations remains poorly understood. The purpose of this study was to examine whether nativity factors (United States (US) citizenship status and length of time residing in the US modify the association between allostatic load (AL), a measure of chronic physiologic stress, and cancer mortality among Hispanic adults. METHODS: We performed a prospective cohort analysis using data from the National Health and Nutrition Examination Survey (NHANES) 1999 - 2010, linked to National Death Index with follow-up through December 31, 2019. Survey-weighted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer mortality, including interaction and age-stratified analyses by US citizenship status, length of time in the US, and country of birth. Fully adjusted models included age, sex, education, year interviewed, smoking status, history of heart attack, and congestive heart failure. RESULTS: Among 7,299 Hispanic adults, 2,835 (33.4% weighted) had high AL. Among Hispanic adults aged ≥ 60 years, individuals with US citizenship and low AL (HR = 3.13; 95% CI = 1.37-7.12), as well as those with US citizenship and high AL (HR = 3.32; 95% CI = 1.18-9.35), experienced more than a three-fold increased risk of cancer mortality compared with non-US citizens with low AL. When examining AL by length of time residing in the US among Hispanic adults aged ≥ 60 years, those with low AL and more than 10 years in the US (HR = 6.32; 95% CI = 1.33-29.90) and those with high AL and more than 10 years in the US (HR = 6.34; 95% CI = 1.17-34.43) had approximately a six-fold increased risk of cancer mortality compared with adults with low AL and less than 10 years in the US. CONCLUSION: Cancer mortality risk among Hispanic adults appears to be driven primarily by older age and nativity-related factors rather than AL risk. These findings highlight the need for future research to more fully examine how structural, social, and immigration-related contexts intersect with aging to influence cancer outcomes among Hispanic populations.