Living alone and all-cause mortality in community-dwelling adults: A systematic review and meta-analysis

Zhao, Yunli; Guyatt, Gordon; Gao, Ya; Qin, Hao; Abdullah, Ream; Basmaji, John; Foroutan, Farid

doi:10.1016/j.eclinm.2022.101677

Cited by 28 publications

(23 citation statements)

References 48 publications

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“…By sex and age group, we found that the association between living alone and cancer mortality risk was similar in males and females but stronger among middle‐aged adults (aged 45–64 years) than other age groups. Similarly, previous studies have reported a stronger association between living alone and all‐cause or cardiovascular disease mortality among adults aged younger than 65 years, particularly among adults aged 45–65 years, compared to adults aged 65 years or older 9,15 . This might be in part explained by differences in health behaviors, such as a higher prevalence of current smoking among middle‐aged individuals who live alone compared to their younger or older counterparts 7 .…”

Section: Discussionmentioning

confidence: 71%

“…7 Previous studies on the association between living alone and mortality by sex, however, have shown mixed findings. Whereas some studies found a stronger association between living alone and all-cause or cardiovascular disease mortality among men than women, 9,13,14,16 other studies found no difference. 12,15 By race/ethnicity, living alone was associated with a higher risk of cancer mortality in both non-Hispanic White and non-Hispanic Black adults but not in other racial/ethnic groups in age-adjusted models.…”

Section: Discussionmentioning

confidence: 93%

“…Similarly, previous studies have reported a stronger association between living alone and all-cause or cardiovascular disease mortality among adults aged younger than 65 years, particularly among adults aged 45-65 years, compared to adults aged 65 years or older. 9,15 This might be in part explained by differences in health behaviors, such as a higher prevalence of current smoking among middle-aged individuals who live alone compared to their younger or older counterparts. 7 Previous studies on the association between living alone and mortality by sex, however, have shown mixed findings.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16] A recent meta-analysis found that, as compared to adults not living alone, living alone was associated with an increase in overall mortality, with a greater risk in young adults than older adults and in males than females. 9 However, only a few studies have evaluated the association between living alone and cancer mortality, [17][18][19] among which only one study on colorectal cancer mortality is from the United States. 17 Findings from other countries may not be applicable to the United States because of possible cultural differences and variations in social support.…”

Section: Introductionmentioning

confidence: 99%

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Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working‐age adults

Lee,

Singh,

Jemal

et al. 2023

Cancer

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BackgroundPrevious studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined.MethodsPooled 1998–2019 data for adults aged 18–64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow‐up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality.ResultsCompared to adults living with others, adults living alone were at a higher risk of cancer death in the age‐adjusted model (HR, 1.32; 95% CI, 1.25–1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04–1.16). Age‐adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non‐Hispanic White adults (HR, 1.33; 95% CI, 1.25–1.42) than non‐Hispanic Black adults (HR, 1.18; 95% CI, 1.05–1.32; p value for difference < .05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05–1.23), women (HR, 1.09; 95% CI, 1.01–1.18), non‐Hispanic White adults (HR, 1.13; 95% CI, 1.05–1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07–1.39).ConclusionsIn this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working‐age adults

Lee,

Singh,

Jemal

et al. 2023

Cancer

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“…Within each theme, multiple indicators can shape recommendations. For example, within the structural component of social connection, countless studies demonstrate that the size and diversity of one's social network, social roles, group participation, frequency of social contact, and living alone all are robust predictors of health and mortality risk (Shor & Roelfs, 2015; Zhao et al, 2022). Similar to physical activity guidelines, national social guidelines could highlight the importance of frequency and duration of social contact and engagement.…”

Section: How To Establish National Guidelines?mentioning

confidence: 99%

National Health Guidelines for Social Connection: What Is the Evidence in Support and What Might the Guidelines Say?

Holt‐Lunstad

2023

Policy Insights from the Behavioral and Brain Sciences

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National health guidelines provide policy makers and the public with recommendations for various behavioral factors known to promote health and reduce disease risk, such as diet and physical activity. Given public health concerns about social isolation, loneliness, and other forms of lacking social connection, the evidence supports establishing national health guidelines for “social connection.” The aggregate body of scientific evidence demonstrates social connection protects health and reduces health risks, pointing to clear relevance for public health. Taken together with national trends suggesting greater social disconnection, there is a compelling case for national preventative efforts. This article summarizes evidence on the health relevance of social connections, potential opportunities, and challenges in establishing and implementing guidelines, the process of establishing guidelines, and provides illustrative evidence-based examples of potential recommendations.

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Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications

Holt‐Lunstad

2024

World Psychiatry

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Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi‐factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer‐term consequences of the COVID‐19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

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Living alone and all-cause mortality in community-dwelling adults: A systematic review and meta-analysis

Cited by 28 publications

References 48 publications

Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working‐age adults

Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working‐age adults

National Health Guidelines for Social Connection: What Is the Evidence in Support and What Might the Guidelines Say?

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications

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