{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:04:52Z","timestamp":1790345092641,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Allostatic load (AL) is a multisystem index of physiological dysregulation due to chronic stress. Although widely applied, its operationalization remains inconsistent, limiting reproducibility and equity. Streamlined indices based on common biomarkers may enhance feasibility across settings. Using data from 150\u2009293 postmenopausal women in the Women\u2019s Health Initiative, we evaluated the construct validity of a streamlined, multisystem AL index. Biomarkers across cardiovascular, metabolic, and immune domains were screened for stable associations with mortality. The final three-component AL index included systolic blood pressure, waist circumference, and white blood cell count. Cox proportional hazards models estimated associations with all-cause, cardiovascular, and immune\/inflammatory mortality, adjusting for demographic and clinical covariates. Higher AL scores were strongly associated with mortality. Hazard ratios for all-cause mortality were 1.34 (95% CI, 1.30\u20131.38), 1.74 (1.68\u20131.80), and 2.27 (2.15\u20132.39) for scores of 1, 2, and 3 versus 0 (Ptrend\u00a0&amp;lt;\u00a00.001), with similar patterns observed for cardiovascular and immune\/inflammatory mortality. A streamlined, multisystem AL index comprised of systolic blood pressure, waist circumference, and white blood cell count demonstrated robust associations with mortality outcomes, supporting the feasibility of such an operationalization of AL, which may enhance reproducibility and extend the applicability of AL indices in large-scale and resource-limited contexts.<\/jats:p>","DOI":"10.1093\/aje\/kwag240","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:12:13Z","timestamp":1790334733000},"source":"Crossref","is-referenced-by-count":0,"title":["Refining Allostatic Load Measurement: Mortality Associations of an Empirically Derived Three-Component Score in the Women\u2019s Health Initiative"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0994-2560","authenticated-orcid":false,"given":"Christine Alison","family":"Cirovic","sequence":"first","affiliation":[{"name":"Health Systems and Population Health, School of Public Health, University of Washington , Seattle, WA ,","place":["United States"]},{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, WA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3419-4539","authenticated-orcid":false,"given":"Paul","family":"Fishman","sequence":"additional","affiliation":[{"name":"Health Systems and Population Health, School of Public Health, University of Washington , Seattle, WA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Casanova","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston-Salem, NC ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0513-1830","authenticated-orcid":false,"given":"Su Yon","family":"Jung","sequence":"additional","affiliation":[{"name":"Translational Sciences Section, School of Nursing; Department of Epidemiology , Fielding School of Public Health; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Nudy","sequence":"additional","affiliation":[{"name":"Department of Medicine and Public Health Sciences, Penn State University , Hershey, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2572-6727","authenticated-orcid":false,"given":"Holly Ruth","family":"Harris","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, WA ,","place":["United States"]},{"name":"Department of Epidemiology, School of Public Health, University of Washington , Seattle, WA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,25]]},"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag240\/71395672\/kwag240.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag240\/71395672\/kwag240.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:37:16Z","timestamp":1790343436000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/advance-article\/doi\/10.1093\/aje\/kwag240\/8835736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/aje\/kwag240","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"kwag240"}}