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Allostatic load predicts racial disparities in intracerebral hemorrhage cognitive outcomes

Jennifer Harris1, Amelia Boehme2, Luisa Chan3

  • 1Division of Stroke and Cerebrovascular Disease, Department of Neurology, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. #A6600, Los Angeles, CA, USA. Jennifer.harris@cshs.org.

Scientific Reports
|October 3, 2022
PubMed

Insights

Allostatic load (AL), a measure of physiological stress, significantly impacts cognitive function after intracerebral hemorrhage (ICH) in Black patients. This finding may help explain racial disparities in stroke outcomes.

Area of Science:

  • Neuroscience
  • Public Health
  • Health Disparities Research

Background:

  • Stroke disparities persist despite accounting for known demographic, comorbidity, and healthcare access factors.
  • Allostatic load (AL), reflecting the cumulative physiological burden of stress, is linked to increased health vulnerability in marginalized populations.
  • Investigating novel factors like AL is crucial for understanding and addressing stroke outcome disparities.

Purpose of the Study:

  • To examine the differential impact of allostatic load (AL) on cognitive outcomes post-intracerebral hemorrhage (ICH) across different race-ethnicity groups.
  • To determine if AL explains a portion of the unexplained disparities in cognitive recovery after ICH.

Main Methods:

  • The study utilized data from the Intracerebral Hemorrhage Outcomes Project (ICHOP), including 248 White, 195 Black, and 261 Hispanic ICH patients.
  • Allostatic load (AL) was quantified using five biomarkers (HbA1c, WBC, SBP, HR, ALB), with an AL score ranging from 0-5.
  • Linear regression models, adjusted for stroke severity and ICH volume, assessed the relationship between AL and cognitive status (TICS-m) at discharge, stratified by race-ethnicity.

Main Results:

  • While mean AL and cognitive status did not differ significantly by race-ethnicity, AL was not associated with cognitive outcomes in White or Hispanic patients.
  • In Black patients, a higher allostatic load (AL) score was significantly associated with lower cognitive status (TICS-m) at discharge (beta -3.2, p=0.049).

Conclusions:

  • Allostatic load (AL) is a significant determinant of post-intracerebral hemorrhage (ICH) cognitive outcomes, particularly for Black patients.
  • AL may account for some of the unexplained health disparities observed in stroke populations.
  • Further research into the role of AL is warranted to develop targeted interventions for improving stroke recovery in minority populations.

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