Association between allostatic load and long-term survival in populations with high or low PSA levels: a national population-based analysis from NHANES 2003–2010

Background The present study aims to investigate the associations between the allostatic load index (ALI), prostate-specific antigen (PSA) levels, and certain causes of death among the participants.Methods Participants in this study were selected from the NHANES database (2003–2010) and linked to mortality files (the National Death Index, 2003–2010). Multivariate Cox proportional hazards models were used to analyze the effect of the allostatic load (AL) on PSA levels and all-cause mortality in participants.Results This study found that an increase in ALI exerted a certain impact on PSA levels in the entire participant population (especially in the subgroup with WWI < 0.5). Participants in the third quartile (T3) with the highest ALI index had a significantly 52% increased probability of all-cause mortality compared to those in T1 (OR = 1.52, 95% CI: 1.28, 1.76, P < 0.01). Both RCS analysis and the K–M curve provide corroboration. When treated as a continuous variable, it is also associated with cardiac mortality (OR = 1.14, 95% CI: 1.04, 1.26, P < 0.01).Conclusions In a specific range, higher ALI was significantly and positively associated with PSA levels, all-cause mortality, and cardiovascular disease risk, though its link to cancer-specific mortality risk was not statistically significant in this study.