Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?
Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?
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DOI：
10.1111/jgs.12410
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发表时间：
2013-09-01
影响因子：
6.3
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
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作者：
Greysen, S. Ryan;Horwitz, Leora I.;Justice, Amy C.
目的比较有和没有人类免疫缺陷病毒（HIV）的老年退伍军人的社会隔离水平，并确定与住院和死亡率的相关性。设计纵向数据分析。设置退伍军人老龄化队列研究（VACS），在全国八个VA医疗中心。2002年至2008年，55岁及以上的退伍军人参加了VACS社会隔离评分（SIS）是使用关于关系状态的基线调查响应创建的;朋友和家人的数量和访问频率;以及参与志愿者工作、宗教或自助团体以及其他社群活动。根据年龄和HIV状态的分数进行比较，并采用多变量回归来评估SIS对入院和全因mortality. ResultsSIS平均值较高的HIV阳性（HIV+）的个人，根据年龄的差异增加（P = 0.01的趋势）。社会隔离也更普遍的艾滋病毒+（59%）比未感染的参与者（51%，P <0.001）。在对HIV+和未感染人群进行的多变量回归分析中，调整人口统计学和临床特征，隔离与更高的住院事件风险（风险率（HR）= 1.25，95%置信区间（CI）= 1.09-1.42）和全因死亡风险（HR=1.28，95% CI = 1.06-1.54）独立相关。HIV+和未感染组分别计算的风险估计值没有显着different.ConclusionSocial隔离与更大的风险住院治疗和死亡的HIV+和未感染的老年退伍军人。尽管这两个群体的影响相似，但社会隔离对艾滋病毒阳性者的人口水平影响可能更大，因为社会隔离的患病率更高，特别是在年龄最大的人中。
ObjectivesTo compare levels of social isolation in aging veterans with and without the human immunodeficiency virus (HIV) and determine associations with hospital admission and mortality.DesignLongitudinal data analysis.SettingThe Veterans Aging Cohort Study (VACS), at eight VA Medical Centers nationally.ParticipantsVeterans aged 55 and older enrolled in VACS from 2002 to 2008 (N = 1,836).MeasurementsA Social Isolation Score (SIS) was created using baseline survey responses about relationship status; number of friends and family and frequency of visits; and involvement in volunteer work, religious or self-help groups, and other community activities. Scores were compared according to age and HIV status, and multivariable regression was used to assess effects of SIS on hospital admission and all-cause mortality.ResultsMean SIS was higher for HIV-positive (HIV+) individuals, with increasing difference according to age (P = .01 for trend). Social isolation was also more prevalent for HIV+ (59%) than uninfected participants (51%, P < .001). In multivariable regression analysis of HIV+ and uninfected groups combined, adjusted for demographic and clinical features, isolation was independently associated with greater risk of incident hospitalization (hazard rate (HR) = 1.25, 95% confidence interval (CI) = 1.09-1.42) and risk of all-cause mortality (HR=1.28, 95% CI = 1.06-1.54). Risk estimates calculated for HIV+ and uninfected groups separately were not significantly different.ConclusionSocial isolation is associated with greater risk of hospitalization and death in HIV+ and uninfected older veterans. Despite similar effects in both groups, the population-level effect of social isolation may be greater in those who are HIV+ because of the higher prevalence of social isolation, particularly in the oldest individuals.