What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: General population (n=1399572). Intervention: Social isolation vs. No social isolation. Primary outcome: All-cause mortality (HR 1.33, 95% CI 1.26-1.41, p=<0.00001).

January 12, 2023Open Access

Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies

Q: What are the key findings of this study?

Social isolation significantly increased the hazard of all-cause mortality by 33% (HR 1.33) compared to no social isolation.

Key Result

Social isolation significantly increased the hazard of all-cause mortality by 33% (HR 1.33) compared to no social isolation.

Study Design

Type

Meta-Analysis (n=1,399,572)

Multicenter

Yes

Structured PICO

Does social isolation increase all-cause mortality in adults?

Population

1,399,572 adults from 36 prospective and retrospective cohort studies, weighted mean age 53 years, multinational.

Intervention

Social isolation (assessed subjectively or objectively using questionnaires such as the Berkman-Syme Social Network Index)

Comparator

No social isolation or lowest levels of social isolation

Outcome

All-cause mortalityhard clinical

Social isolation is significantly associated with a 33% increased risk of all-cause mortality, highlighting it as a major psychosocial risk factor.

Main Result

Effect estimate: HR 1.33 (95% CI 1.26-1.41)

p-value: p=<0.00001

Limitations

Proof of a causal association between social isolation to mortality cannot be established from observational data
Cannot exclude further confounding from unmeasured confounders such as mental illness, personality disorders, or fear of crime
Substantial heterogeneity in the study populations of the included studies
Selection bias due to HR as the measurement of the effect estimates
HR may change over time during the follow-up period, making the observed effect estimates less reliable

Abstract

BACKGROUND: Although several epidemiological studies have linked social isolation to increased risk of mortality, the magnitude of any effect is unclear, in part because of the use of different measures of social isolation. OBJECTIVE: To examine the association between social isolation and all-cause mortality and investigate whether it differs in various subgroups or populations. DATA SOURCES: We searched for relevant studies in electronic databases: MEDLINE (1946 to December 31, 2021), EMBASE (1974 to December 31, 2021), and PsycINFO (1806 to December 31, 2021). SELECTION CRITERIA: We included both prospective and retrospective cohort studies that examined the association between social isolation and all-cause mortality among adults. DATA COLLECTION AND ANALYSIS: Two reviewers screened and extracted data independently. We contacted study authors to obtain missing information whenever possible. Data were pooled using a random effect model to calculate estimates of the effects of social isolation on all-cause mortality. RESULTS: Data from studies involving 1.30 million individuals were included. The pooled hazard ratio of social isolation for all-cause mortality was 1.33 (95% confidence interval; 1.26-1.41, heterogeneity: Chi² = 112.51, P < 0.00001, I² = 76%). CONCLUSION: Social isolation is associated with increased risk for all-cause mortality. REGISTRATION: PROSPERO (CRD42020152351).

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