Pilot study of allostatic load, area deprivation, and race in endometrioid endometrial cancer.

Abstract

e17631 Background: Area Deprivation Index (ADI) is a validated neighborhood-level metric of socioeconomic disadvantage. High ADI has been linked to worse healthcare outcomes, including in cancer populations. Similarly, high allostatic load (AL)—a biomarker reflecting the cumulative biological damage resulting from chronic socioenvironmental stress—has been linked to increased cancer risk, poorer survival, and membership within marginalized communities. We hypothesized that AL may be one mediator for the reported association of high ADI with adverse cancer outcomes, as well as racial disparities in cancer outcomes. This pilot study aimed to evaluate, within a sociodemographically diverse cohort of early stage endometrioid endometrial cancer (EEC) patients, the relationship of AL with ADI and race. Methods: Patients were identified using one institution’s IRB-approved database with electronic medical record and cancer registry information. Patients diagnosed with stage I-III EEC between 2008 and 2025 who had all AL variables available between 12 months prior to and 6 months after diagnosis were included. AL was calculated using a standard method assessing systolic and diastolic blood pressure, body mass index, heart rate, leukocyte count, alkaline phosphatase, blood glucose, creatinine, blood urea nitrogen, and albumin. Values closest to diagnosis date were used. Patients received 1 point per biomarker in the high-risk quartile: ≥75th percentile for all markers except albumin, for which ≤25th percentile was used. Points were summed to generate total AL scores. Spearman’s correlation measured the association of AL with continuous national ADI rank. Wilcoxon test compared AL by Black versus White race. Results: 220 patients met criteria. Of these, 26.8% identified as Black and 68.6% as White. 17.7% of patients resided within the most disadvantaged ADI quartile 4, 35% in ADI quartile 3, and 33.6% in quartile 2. Total AL was positively associated with national ADI rank (ρ = 0.18, p = 0.009). In contrast, total AL did not have a significant association with Black versus White race. At last follow-up, 21 (9.5%) patients had recurrence, an insufficient sample size for examining the relationship of AL and cancer outcomes. Conclusions: In this sociodemographically diverse, histologically uniform cohort, AL was associated with ADI but not race. These results suggest that the relationship of ADI with cancer outcomes may, in part, be mediated by AL. Our results also indicate race may be an oversimplified proxy for physiologic stress, which may be better represented by more comprehensive measures of health vulnerability. Together, these findings highlight the contribution of structural and environmental factors to biologic damage. Further studies integrating AL, ADI, and their effects on oncologic outcomes are needed to better inform equity-focused strategies addressing adverse outcomes in vulnerable populations.