December 16, 2019Psychosomatic Medicine110 citationsOpen Access
Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study
Key Result
Social isolation was associated with a significantly increased risk of all-cause mortality (HR 1.16) in older patients with cardiovascular disease, independent of loneliness.
Study Design
Type
Cohort (n=1,267)
Structured PICO
Do social isolation and loneliness increase the risk of mortality in older patients with established cardiovascular disease?
P
Population
1,267 older adults aged 65 years or older with established cardiovascular disease in Taiwan, followed for up to 10 years.
E
Exposure
Social isolation and loneliness (observational exposure)
O
Outcome
All-cause mortality at up to 10 years follow-uphard clinical
Social isolation, but not loneliness, is independently associated with an increased risk of all-cause mortality in older patients with established cardiovascular disease.
Main Result
Hazard Ratio: 1.16 (95% CI 1.06–1.26)
Absolute Event Rate: 65% vs 41.3%
Limitations
- Possibility of reverse causality where social isolation might reflect more serious illness rather than isolation per se
- Potential for unmeasured confounding factors
Abstract
OBJECTIVE: Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan. METHODS: The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status. RESULTS: There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio HR = 1.16; 95% confidence interval CI = 1.06-1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82-1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07-1.27). CONCLUSIONS: Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.