Social isolation, loneliness, and all-cause mortality in older men and women
Social isolation, loneliness, and all-cause mortality in older men and women
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DOI：
10.1073/pnas.1219686110
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发表时间：
2013-04-09
影响因子：
11.1
通讯作者：
Wardle, Jane
中科院分区：
文献类型：
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作者：
Steptoe, Andrew;Shankar, Aparna;Wardle, Jane
社交孤立和孤独都与死亡率增加有关，但尚不确定它们的影响是否独立，或者孤独是否代表社交孤立损害健康的情感途径。因此，我们评估了社会孤立和死亡率之间的关联在多大程度上是由孤独介导的。我们在2004-2005年参加英国老龄化纵向研究的6,500名52岁及以上的男性和女性中，评估了与家人和朋友接触以及参与民间组织的社会隔离。一个标准的问卷调查孤独的措施也管理。我们监测了截至2012年3月的全因死亡率（平均随访7.25年），并使用考克斯比例风险回归分析结果。我们发现，在社会孤立和孤独的参与者中，死亡率更高。然而，在对人口统计学因素和基线健康进行统计学调整后，社会隔离仍然与死亡率显著相关（风险比1.26，95%置信区间，隔离的前五分之一为1.08 - 1.48），但孤独感则没有（风险比0.92，95%置信区间，0.78-1.09）。当孤独被纳入模型时，社会孤立与死亡率的关系没有变化。社会孤立和孤独都与死亡率增加有关。然而，孤独的影响并不独立于人口特征或健康问题，也不会增加与社会隔离相关的风险。虽然隔离和孤独都会损害生活质量和福祉，但减少隔离的努力可能与死亡率更相关。
Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004-2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox pro- portional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.081.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.