Psychosocial Stress and Allostatic Load Among Underrepresented Minority Women with Familial Cancer Risk
- 1University of California, Los Angeles
Abstract
ImportanceChronic stress may contribute to adverse health outcomes through cumulative physiologic dysregulation. Allostatic load (AL), a composite measure of multisystem physiologic burden, may capture biologic effects of structural, social, and psychosocial stress not reflected by self-reported measures.
ObjectiveTo evaluate racial and ethnic differences in AL among women with familial cancer risk and examine how socioeconomic status, psychosocial factors, clinical characteristics, and health behaviors contribute to variations in AL.
DesignCross-sectional study of underrepresented minority participants enrolled in the HERSTORY cohort from October 2023 through September 2025, with comparison participants from the UCLA ATLAS biobank.
SettingUCLA academic health system.
ParticipantsThe study included 303 racially and ethnically diverse female HERSTORY participants aged [≥]35 years with a family history of cancer and matched non-Hispanic White female ATLAS participants (n=709).
ExposuresRace and ethnicity, age, neighborhood deprivation, cancer history and stage, depression, perceived stress, cancer worry, and physical activity.
Main Outcomes and MeasuresThe primary outcome was AL, calculated from cardiometabolic and organ-function measures. A secondary index incorporated race- and ethnicity-specific neutrophil-to-lymphocyte ratio (NLR) derived from 326,826 women in the UCLA Health population. Multivariable regression models evaluated factors associated with elevated AL.
ResultsCompared with matched non-Hispanic White participants, Black and Asian/Pacific Islander HERSTORY participants had significantly higher AL after adjustment. Hispanic/Latina participants did not have significantly elevated AL. Older age, greater area-level socioeconomic deprivation, and depression were independently associated with higher AL. Prior cancer diagnosis, cancer worry and perceived stress were not significantly associated with AL, whereas regular physical activity was associated with lower AL. Among cancer patients, advanced stage was associated with greater AL.
Conclusions and RelevanceThis study demonstrates elevated AL among understudied racial/ethnic minority groups with familial cancer risk and identifies associations with neighborhood deprivation, depression, and physical activity. The association between cancer stage and AL suggests that physiologic stress may reflect variation in cancer burden. The lack of association with perceived stress and cancer worry further indicates that physiologic and self-reported psychosocial measures capture distinct dimensions of stress. The development of race/ethnicity-specific NLR thresholds derived from large population samples provide a benchmark for future studies.
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BibTeX
@misc{shachar2026psychosocial,
title = {{Psychosocial Stress and Allostatic Load Among Underrepresented Minority Women with Familial Cancer Risk}},
author = {E. K. Shachar and R. Haas and V. E. Rodriguez and J. Lester and M. A. Siavoshi and L. Kwan and M. Niell-Swiller and P. T. Spellman and P. C. Boutros and V. Y. Chang and B. Y. Karlan},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.26.26361226},
url = {https://www.medrxiv.org/content/10.64898/2026.08.26.26361226v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - Psychosocial Stress and Allostatic Load Among Underrepresented Minority Women with Familial Cancer Risk
AU - E. K. Shachar
AU - R. Haas
AU - V. E. Rodriguez
AU - J. Lester
AU - M. A. Siavoshi
AU - L. Kwan
AU - M. Niell-Swiller
AU - P. T. Spellman
AU - P. C. Boutros
AU - V. Y. Chang
AU - B. Y. Karlan
PY - 2026
DA - 2026/08/26
PB - medRxiv
DO - 10.64898/2026.08.26.26361226
UR - https://www.medrxiv.org/content/10.64898/2026.08.26.26361226v1
AB - ImportanceChronic stress may contribute to adverse health outcomes through cumulative physiologic dysregulation. Allostatic load (AL), a composite measure of multisystem physiologic burden, may capture biologic effects of structural, social, and psychosocial stress not reflected by self-reported measures. ObjectiveTo evaluate racial and ethnic differences in AL among women with familial cancer risk and examine how socioeconomic status, psychosocial factors, clinical characteristics, and health behaviors contribute to variations in AL. DesignCross-sectional study of underrepresented minority participants enrolled in the HERSTORY cohort from October 2023 through September 2025, with comparison participants from the UCLA ATLAS biobank. SettingUCLA academic health system. ParticipantsThe study included 303 racially and ethnically diverse female HERSTORY participants aged [≥]35 years with a family history of cancer and matched non-Hispanic White female ATLAS participants (n=709). ExposuresRace and ethnicity, age, neighborhood deprivation, cancer history and stage, depression, perceived stress, cancer worry, and physical activity. Main Outcomes and MeasuresThe primary outcome was AL, calculated from cardiometabolic and organ-function measures. A secondary index incorporated race- and ethnicity-specific neutrophil-to-lymphocyte ratio (NLR) derived from 326,826 women in the UCLA Health population. Multivariable regression models evaluated factors associated with elevated AL. ResultsCompared with matched non-Hispanic White participants, Black and Asian/Pacific Islander HERSTORY participants had significantly higher AL after adjustment. Hispanic/Latina participants did not have significantly elevated AL. Older age, greater area-level socioeconomic deprivation, and depression were independently associated with higher AL. Prior cancer diagnosis, cancer worry and perceived stress were not significantly associated with AL, whereas regular physical activity was associated with lower AL. Among cancer patients, advanced stage was associated with greater AL. Conclusions and RelevanceThis study demonstrates elevated AL among understudied racial/ethnic minority groups with familial cancer risk and identifies associations with neighborhood deprivation, depression, and physical activity. The association between cancer stage and AL suggests that physiologic stress may reflect variation in cancer burden. The lack of association with perceived stress and cancer worry further indicates that physiologic and self-reported psychosocial measures capture distinct dimensions of stress. The development of race/ethnicity-specific NLR thresholds derived from large population samples provide a benchmark for future studies.
ER -