Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study.
Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study.
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DOI：
10.1016/s2468-2667(17)30075-0
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Kivimäki M
中科院分区：
文献类型：
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作者：
Elovainio M;Hakulinen C;Pulkki-Råback L;Virtanen M;Josefsson K;Jokela M;Vahtera J;Kivimäki M
社会孤立和孤独与过早死亡的关联是众所周知的，但将它们联系起来的风险因素仍不清楚。我们试图找出可能解释社交孤立和孤独个体死亡率增加的风险因素。我们使用来自英国生物银行队列研究的前瞻性随访数据来评估自我报告的隔离（三项量表）和孤独（两个问题）。主要结局为全因和特定原因死亡率。我们计算了由危险因素介导的过度风险的百分比，以评估社交孤立和孤独与死亡率的关联在多大程度上归因于孤立和孤独的个体与其他个体之间的生物学差异。（体重指数、收缩压和舒张压以及握力）、行为（吸烟、饮酒和体育活动）、社会经济（教育、邻里贫困和家庭收入）和心理（抑郁症状和认知能力）风险因素。466901名男性和女性（基线时平均年龄56.5岁[SD 8.1]）被纳入分析，平均随访时间为6.5年（SD 0.8）。 与没有社会隔离相比，社会隔离的全因死亡率风险比为1·73（95% CI 1.65 - 1.82）调整年龄、性别、种族和慢性疾病后（即，最小调整），为1·26（95% CI 1.20 - 1.33）进一步调整社会经济因素、健康相关行为、抑郁症状、生物学因素、认知表现后，和自我评估的健康（即完全调整）。与孤独相关的死亡风险的最小调整风险比为1.38（95%CI 1.30 - 1.47），在完全调整基线风险后降至0.99（95%CI 0.93 - 1.06）。孤立和孤独的人死亡的风险增加。针对不利的社会经济条件，不健康的生活方式和较低的心理健康等风险因素的卫生政策可能会降低孤立和孤独人群的过度死亡率。芬兰科学院、NordForsk和英国医学研究理事会。
The associations of social isolation and loneliness with premature mortality are well known, but the risk factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals. We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation (a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors. 466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65–1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20–1·33) after further adjustment for socioeconomic factors, health-related behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30–1·47), which reduced to 0·99 (95% CI 0·93–1·06) after full adjustment for baseline risks. Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely. Academy of Finland, NordForsk, and the UK Medical Research Council.