Social Isolation and Mortality in US Black and White Men and Women

Abstract

Social isolation is associated with higher mortality in studies comprising mostly white adults, yet associations among black adults are unclear. In this prospective cohort study, we evaluated whether associations of social isolation with allcause, cardiovascular disease, and cancer mortality differed by race and sex. Adults enrolled in Cancer Prevention Study II in 1982/1983 were followed for mortality through 2012 (n = 580,182). Sex-and race-specific multivariableadjusted hazard ratios and 95% confidence intervals were estimated for associations of a 5-point social isolation score with risk of death. Social isolation was associated with all-cause mortality in all subgroups (P for trend ≤ 0.005); for the most isolated versus the least isolated, the hazard ratios were 2.34 (95% confidence interval (CI): 1.58, 3.46) and 1.60 (95% CI: 1.41, 1.82) among black men and white men, respectively (P for interaction = 0.40) and 2.13 (95% CI: 1.44, 3.15) and 1.84 (95% CI: 1.68, 2.01) among black women and white women, respectively (P for interaction = 0.89). The association did not differ between black men and black women (P for interaction = 0.33) but was slightly stronger in white women than in white men (P for interaction = 0.01). Social isolation was associated with cardiovascular disease mortality in each subgroup (P for trend < 0.03) but with cancer mortality only among whites (P for trend < 0.0001). Subgroup differences in the influence of specific social isolation components were identified. Identifying and intervening with socially isolated adults could improve health outcomes.

Gender Differences in the Social Determinants of the Long-term Prognosis for Severely Decompensated Acute Heart Failure in Patients over 75 Years of Age

“…Among patients with coronary artery disease, male patients who are divorced or widowed show a poorer prognosis than married male patients (22,23). Furthermore, according to the Cancer Prevention Study-II report, among Caucasians, the HR for the all-cause mortality was higher in non-married men than in non-married women (24). However, there have been some reports showing that women are more sensitive and vulnerable to psychosocial stress, financial stress, or social isolation than men, which might affect the progression of HF and CVD (25-27).…”

COVID‐19 in the geriatric population

“…25 An epidemiologic study amongst all races found a strong correlation between social isolation and all-cause mortality during a 30-year follow up period. 26 The theory underlying these repercussions are proposed to be from multiple etiologies.…”

“…It may also alter healthy behavioral practices with physical activity, sleep hygiene, and even medical adherence leading to overall poor outcomes. 26 In terms of COVID-19, it is crucial to understand that these social isolation and loneliness issues are the baseline for the older population. How additional social distancing recommendations will enhance social isolation and loneliness is still to be determined.…”

Social Isolation Associated with Future Health Care Utilization

“…[1][2][3] Social isolation is consistently associated with poor health outcomes [4][5][6][7][8] and increased mortality. [9][10][11][12][13] Social isolation is particularly prevalent in older populations, affecting an estimated 17%-24% of older adults. 14,15 Although previous research 16 has shown that documented social and economic needs in the electronic health record are associated with future emergency department (ED) and hospital utilization, limited research has examined the specific effects of social isolation on health care utilization.…”