Key result
Social group participation links to ~35% higher AF incidence, while poor connectedness predicts higher mortality.
Why the study?
Social isolation may mark poor health and higher mortality, but its association with incident AF and death warranted evaluation.
Does social isolation affect the risk of incident atrial fibrillation and mortality in adults aged ≥ 55 years?
Cohort (n=3,454)
No
Does social isolation affect the risk of incident atrial fibrillation and mortality in adults aged ≥ 55 years?
Effect estimate: sHR 1.35 (95% CI 1.16-1.57)
p-value: p=0.0001
Social isolation is associated with increased mortality without AF, while the seemingly lower AF incidence in isolated individuals is likely an artifact of the competing risk of death.
Social isolation may artifactually lower observed AF incidence via competing mortality; this observational link leaves open any causal role for social connectedness.
Social isolation might be considered as a marker of poor health and higher mortality. The aim of our analysis was to assess the association of social network index (SNI) with incident AF and death. We selected participants aged ≥ 55 years without prevalent AF from the Framingham Heart Study. We evaluated the association between social isolation measured by the Berkman-Syme Social Network Index (SNI), incident AF, and mortality without diagnosed AF. We assessed the risk factor-adjusted associations between SNI (the sum of 4 components: marriage status, close friends/relatives, religious service attendance, social group participation), incident AF, and mortality without AF by using Fine-Gray competing risk regression models. We secondarily examined the outcome of all-cause mortality. We included 3454 participants (mean age 67 ± 10 years, 58% female). During 11.8 ± 5.2 mean years of follow-up, there were 686 incident AF cases and 965 mortality without AF events. Individuals with fewer connections had lower rates of incident AF (P = 0.04) but higher rates of mortality without AF (P = 0.03). Among SNI components, only social group participation was associated with higher incident AF (subdistribution hazards ratio [sHR] 1.35, 95% CI 1.16-1.57, P = 0.0001). For mortality without AF, social group participation (sHR = 0.81, 95% CI 0.71-0.93, P = 0.002) and regular religious service attendance sHR = 0.76, 95% CI 0.67-0.87, P < 0.0001) were associated with lower risk of death. Social isolation was associated with a higher rate of mortality without diagnosed AF. In contrast to our hypothesis, we observed that poor social connectedness was associated with a lower rate of incident AF. This finding should be interpreted cautiously since there were very few participants in the lowest social connectedness group. Additionally, the seemingly protective effect of social isolation on AF incidence may be simply an artifact of the strong association between social isolation and increased mortality rate in combination with the large number of deaths as compared to AF events in our study. Further study is warranted.
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Kornej et al. (2022) conducted a cohort in Atrial fibrillation (n=3,454). Social group participation vs. No social group participation was evaluated on Incident atrial fibrillation (sHR 1.35, 95% CI 1.16-1.57, p=0.0001). Social group participation was associated with a higher incidence of atrial fibrillation (sHR 1.35), whereas overall poor social connectedness was associated with lower incident AF but higher mortality.
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