Social relationships and mortality risk: a meta-analytic review.
Social relationships and mortality risk: a meta-analytic review.
复制标题
DOI：
10.1371/journal.pmed.1000316
复制
发表时间：
2010-07-27
期刊：
影响因子：
15.8
通讯作者：
Layton JB
中科院分区：
文献类型：
--
作者：
Holt-Lunstad J;Smith TB;Layton JB
在一项荟萃分析中，Julianne Holt-Lunstad及其同事发现，个人的社会关系对死亡风险的影响与吸烟等其他公认的死亡风险因素一样大。个人社会关系的质量和数量不仅与心理健康有关，而且与发病率和死亡率有关。本荟萃分析综述旨在确定社会关系对死亡风险的影响程度，社会关系的哪些方面最具预测性，以及哪些因素可能会降低风险。提取了一些参与者特征的数据，包括死亡原因、初始健康状况和先前的健康状况，以及研究特征，包括随访时间和社会关系评估类型。在148项研究（308,849名参与者）中，随机效应加权平均效应大小OR = 1.50 (95% CI 1.42至1.59)，表明社会关系较强的参与者的生存可能性增加50%。这一发现在年龄、性别、初始健康状况、死亡原因和随访期间保持一致。在评估的社会测量类型中发现显著差异（p<0.001）；这种关联在社会融合的复杂测量中最强（OR = 1.91; 95% CI 1.63至2.23），在居住状态的二元指标（独居与与他人生活）中最低（OR = 1.19; 95% CI 0.99至1.44）。社会关系对死亡风险的影响与公认的死亡风险因素相当。请参阅文章后面的编辑总结，人类天生具有社会性。然而，工业化国家的现代生活方式正在大大降低社会关系的数量和质量。这些国家的许多人不再住在大家庭里，甚至不住得很近。相反，他们经常住在国家的另一边，甚至与他们的亲戚住在世界的另一端。许多人还推迟结婚和生孩子。同样，在发达国家，越来越多的各个年龄段的人独自生活，孤独变得越来越普遍。在英国，根据心理健康基金会最近的一项调查，10%的人经常感到孤独，三分之一的人有一个亲密的朋友或亲戚，他们认为他们非常孤独，一半的人认为人们总体上越来越孤独。同样，在大西洋彼岸，在过去的二十年里，说自己没有知己的美国人的数量增加了三倍。有理由相信人们在社会上变得越来越孤立。一些专家认为社会孤立对人体健康有害。他们指出，1988年对五项前瞻性研究（在调查中，确定一个人群的特征，然后跟踪观察这些特征是否与特定的结果有关）的回顾表明，社会关系较少的人平均比社会关系较多的人死得早。但是，尽管自第一次审查以来，许多关于死亡率（死亡）的前瞻性研究都包括了社会关系的衡量标准，但缺乏社会关系是死亡的一个风险因素这一观点仍然没有得到卫生组织和公众的广泛认可。因此，在本研究中，研究人员对相关文献进行了系统的回顾和荟萃分析，以确定社会关系对死亡风险的影响程度，以及社会关系的哪些方面最能预测死亡率。系统综述使用预定义的标准来确定给定主题的所有研究；荟萃分析使用统计方法将几项研究的结果结合起来。研究人员确定了148项前瞻性研究，这些研究提供了个人死亡率作为社会关系函数的数据，并从每项研究中提取了“效应大小”。效应量量化了两组之间差异的大小——这里指的是社会关系不同的两组之间死亡可能性的差异。然后，研究人员使用一种称为“随机效应建模”的统计方法来计算这些研究的平均效应大小，以比值比（OR）表示，即一组事件发生的几率与另一组事件发生的几率之比。他们报告说，平均OR是1.5。也就是说，社会关系较强的人比社会关系较弱的人生存的可能性高50%。换句话说，OR为1.5意味着当100个人的假设样本中有一半人死亡时，社会关系较强的人比社会关系较弱的人多5个。重要的是，研究人员还报告说，在考虑社会整合的复杂测量的研究中，社会关系比考虑婚姻状况等简单评估的研究更能预测死亡风险。这些研究结果表明，社会关系对死亡风险的影响与吸烟和饮酒等公认的死亡风险因素相当，超过了缺乏运动和肥胖等其他风险因素的影响。此外，本荟萃分析中报告的社会关系对死亡率的总体影响可能被低估了，因为许多研究使用了简单的单项社会隔离测量方法，而不是复杂的测量方法。研究人员总结说，虽然还需要进一步的研究来确定如何利用社会关系来降低死亡风险，但医生、卫生专业人员、教育工作者和媒体现在应该承认社会关系影响成年人的健康结果，应该像对待其他影响死亡率的风险因素一样认真对待社会关系。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1000316访问这些网站。英国慈善机构心理健康基金会（Mental Health Foundation）有关于孤独和心理健康的信息；梅奥诊所有关于社会支持作为一种管理压力的方法的信息皮尤研究基金会有关于技术和社会隔离的信息维基百科有一个关于社会隔离的页面（注意维基百科是一个免费的在线百科全书，任何人都可以编辑；有多种语言版本）
In a meta-analysis, Julianne Holt-Lunstad and colleagues find that individuals' social relationships have as much influence on mortality risk as other well-established risk factors for mortality, such as smoking. The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality. This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk. Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships. Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44). The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary Humans are naturally social. Yet, the modern way of life in industrialized countries is greatly reducing the quantity and quality of social relationships. Many people in these countries no longer live in extended families or even near each other. Instead, they often live on the other side of the country or even across the world from their relatives. Many also delay getting married and having children. Likwise, more and more people of all ages in developed countries are living alone, and loneliness is becoming increasingly common. In the UK, according to a recent survey by the Mental Health Foundation, 10% of people often feel lonely, a third have a close friend or relative who they think is very lonely, and half think that people are getting lonelier in general. Similarly, across the Atlantic, over the past two decades there has been a three-fold increase in the number of Americans who say they have no close confidants. There is reason to believe that people are becoming more socially isolated. Some experts think that social isolation is bad for human health. They point to a 1988 review of five prospective studies (investigations in which the characteristics of a population are determined and then the population is followed to see whether any of these characteristics are associated with specific outcomes) that showed that people with fewer social relationships die earlier on average than those with more social relationships. But, even though many prospective studies of mortality (death) have included measures of social relationships since that first review, the idea that a lack of social relationships is a risk factor for death is still not widely recognized by health organizations and the public. In this study, therefore, the researchers undertake a systematic review and meta-analysis of the relevant literature to determine the extent to which social relationships influence mortality risk and which aspects of social relationships are most predictive of mortality. A systematic review uses predefined criteria to identify all the research on a given topic; a meta-analysis uses statistical methods to combine the results of several studies. The researchers identified 148 prospective studies that provided data on individuals' mortality as a function of social relationships and extracted an “effect size” from each study. An effect size quantifies the size of a difference between two groups—here, the difference in the likelihood of death between groups that differ in terms of their social relationships. The researchers then used a statistical method called “random effects modeling” to calculate the average effect size of the studies expressed as an odds ratio (OR)—the ratio of the chances of an event happening in one group to the chances of the same event happening in the second group. They report that the average OR was 1.5. That is, people with stronger social relationships had a 50% increased likelihood of survival than those with weaker social relationships. Put another way, an OR of 1.5 means that by the time half of a hypothetical sample of 100 people has died, there will be five more people alive with stronger social relationships than people with weaker social relationships. Importantly, the researchers also report that social relationships were more predictive of the risk of death in studies that considered complex measurements of social integration than in studies that considered simple evaluations such as marital status. These findings indicate that the influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity and obesity. Furthermore, the overall effect of social relationships on mortality reported in this meta-analysis might be an underestimate, because many of the studies used simple single-item measures of social isolation rather than a complex measurement. Although further research is needed to determine exactly how social relationships can be used to reduce mortality risk, physicians, health professionals, educators, and the media should now acknowledge that social relationships influence the health outcomes of adults and should take social relationships as seriously as other risk factors that affect mortality, the researchers conclude. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000316. The Mental Health America Live Your Life Well page includes information about how social relationships improve both mental and physical health The Mental Health Foundation, a UK charity, has information on loneliness and mental health; its report “The Lonely Society?” can be downloaded from this page The Mayo Clinic has information on social support as a way to manage stress The Pew Research Foundation has information on technology and social isolation Wikipedia has a page on social isolation (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)
登录
查看更多内容
影响因子：
--
作者：
Bygren, LO;Konlaan, BB;Johansson, SE
通讯作者：
Johansson, SE
影响因子：
5.4
作者：
Avlund, K;Damsgaard, MT;Holstein, BE
通讯作者：
Holstein, BE
DOI：
10.1046/j.1532-5415.2001.49148.x
发表时间：
2001-06-01
影响因子：
6.3
作者：
Ceria, CD;Masaki, KH;Curb, JD
通讯作者：
Curb, JD
影响因子：
8.2
作者：
Brown, SL;Nesse, RM;Smith, DM
通讯作者：
Smith, DM
DOI：
10.1093/geronb/59.1.s44
发表时间：
2004-01-01
影响因子：
6.2
作者：
Avlund, K;Lund, R;Heikkinen, RL
通讯作者：
Heikkinen, RL