Differences in Loneliness Across the Rural‐Urban Continuum Among Adults Living in Washington State

PURPOSE: Rural residents may be at higher risk for loneliness than urban residents due to factors such as social isolation, poorer health, and socioeconomic disadvantage. To date, there have been few studies examining rural-urban differences in loneliness among adults in the United States. We examined differences in loneliness across the rural-urban continuum among adult residents living in Washington State. METHODS: Stratified random sampling was used to select 2,575 adults from small rural, large rural, suburban, and urban areas who were invited to complete a survey on factors affecting health. Data were obtained from 616 adults (278 from small rural, 100 from large rural, 98 from suburban, and 140 from urban areas) from June 2018 through October 2019. Loneliness was measured using the UCLA Loneliness Scale (3rd version). Multivariable linear and logistic regressions were used to examine geographic differences in loneliness (measured continuously and dichotomously). FINDINGS: Mean unadjusted loneliness scores were lower in suburban compared to urban areas (35.06 vs 38.57, P = .03). The prevalence of loneliness was 50.7%, 59.0%, 40.8%, and 54.3% in small rural, large rural, suburban, and urban areas, respectively. Suburban living was associated with lower odds for being lonely compared to urban living (unadjusted OR = 0.58; 95% CI = 0.34-0.98), but this association was not statistically significant in the adjusted model (OR = 0.63; 95% CI = 0.33-1.19). CONCLUSION: Loneliness is a prevalent health issue across the rural-urban continuum among Washington State adults.