Trajectories of allostatic load among older Americans and Britons: longitudinal cohort studies

Difference in life expectancy between males and females has been suggested to rest on sex difference in physiological dysregulation. But allostatic load, a physiological index, has not been carefully examined for an extended period beyond middle age. We aim to draw longitudinal trajectories of allostatic load in a national sample of older Americans and Britons; also to examine sex-based trajectories and factors behind their differences.

We studied men and women aged ≥50 years participating in the Health and Retirement Study Waves 8–11, 2006–2012 (N = 15,583 person-years) and the English Longitudinal Study of Ageing Waves 2, 4 and 6, 2004–2012 (N = 14,765 person-years). Because of the difference in provenance, we included different number of biomarkers to calculate allostatic load in HRS and ELSA. In HRS we used 8 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, cystatin C, and C-reactive protein), while ELSA allostatic load was constructed from 10 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, BMI, triglyceride, fibrinogen and C-reactive protein). A growth curve model was fitted to repeated observations of allostatic load, demographic characteristics, socioeconomic position, comorbidities and health behaviours (smoking, drinking, and physical exercise). To account for attrition, a joint model was applied.

The analysis showed that allostatic load increases linearly with age in the U.S. However, there are different levels for males and females. In England allostatic load follows such different paths that their trajectories cross in later life.

Sex-based trajectories of allostatic load showed distinct female advantage and are mostly consistent with female advantage in life expectancy.