A1 Refereed original research article in a scientific journal
Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study.
Authors: Marko Elovainio, Christian Hakulinen, Laura Pulkki-Råback, Marianna Virtanen, Kim Josefsson, Markus Jokela, Jussi Vahtera, Mika Kivimäki
Publisher: The Lancet Publishing Group
Publication year: 2017
Journal: Lancet Public Health
Journal name in source: The Lancet. Public health
Journal acronym: Lancet Public Health
Volume: 2
Issue: 6
First page : e260
Last page: e266
Number of pages: 7
ISSN: 2468-2667
DOI: https://doi.org/10.1016/S2468-2667(17)30075-0
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/28606423
Background
The associations of social isolation and loneliness with premature mortality are well known, but the risk
factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals.
Methods
We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation
(a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors.
Findings
466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a
mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65–1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20–1·33) after further adjustment for socioeconomic factors, healthrelated behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30–1·47), which reduced to 0·99 (95% CI 0·93–1·06) after full adjustment for baseline risks.
Interpretation Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely.
Funding
Academy of Finland, NordForsk, and the UK Medical Research Council.
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