Santini Ziggi Ivan, Koyanagi Ai, Tyrovolas Stefanos, Haro Josep M, Fiori Katherine L, Uwakwa Richard, Thiyagarajan Jotheeswaran A, Webber Martin, Prince Martin, Prina A Matthew
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
Soc Sci Med. 2015 Dec;147:134-43. doi: 10.1016/j.socscimed.2015.10.061. Epub 2015 Nov 4.
Restricted social networks have been associated with higher mortality in several developed countries but there are no studies on this topic from developing countries. This gap exists despite potentially greater dependence on social networks for support and survival due to various barriers to health care and social protection schemes in this setting. Thus, this study aims to examine how social network type at baseline predicts all-cause mortality among older adults in six Latin American countries, China, and India.
Population-based surveys were conducted of all individuals aged 65+ years in eight countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, China, and India). Data on mortality were obtained at follow-up (mean 3.8 years after cohort inception). Follow-up data for 13,891 individuals were analysed. Social network types were assessed using Wenger's Practitioner Assessment of Network Type (PANT). Cox proportional hazard models were constructed to estimate the impact of social network type on mortality risk in each country, adjusting for socio-demographics, receipt of pension, disability, medical conditions, and depression. Meta-analysis was performed to obtain pooled estimates.
The prevalence of private network type was 64.4% in urban China and 1.6% in rural China, while the prevalence of locally integrated type was 6.6% in urban China and 86.8% in rural China. The adjusted pooled estimates across (a) all countries and (b) Latin America showed that, compared to the locally integrated social network type, the locally self-contained [(b) HR = 1.24, 95% CI 1.01-1.51], family dependent [(a) HR = 1.13, 95% CI 1.01-1.26; (b) HR = 1.13, 95% CI 1.001-1.28], and private [(a) HR = 1.36, 95% CI 1.06-1.73; (b) HR = 1.45, 95% CI 1.20-1.75] social network types were significantly associated with higher mortality risk.
Survival time is significantly reduced in individuals embedded in restricted social networks (i.e. locally self-contained, family dependent, and private network types). Social care interventions may be enhanced by addressing the needs of those most at risk of neglect and deteriorating health. Health policy makers in developing countries may use this information to plan efficient use of limited resources by targeting those embedded in restricted social networks.
在几个发达国家，社交网络受限与较高的死亡率相关，但发展中国家尚未有关于这一主题的研究。尽管在这种情况下，由于医疗保健和社会保护计划存在各种障碍，人们可能对社交网络的支持和生存依赖更大，但这一差距仍然存在。因此，本研究旨在探讨基线时的社交网络类型如何预测六个拉丁美洲国家、中国和印度老年人的全因死亡率。
对八个国家（古巴、多米尼加共和国、秘鲁、委内瑞拉、墨西哥、波多黎各、中国和印度）所有65岁及以上的个体进行基于人群的调查。随访时获取死亡率数据（队列开始后平均3.8年）。对13,891名个体的随访数据进行了分析。使用温格的网络类型从业者评估（PANT）来评估社交网络类型。构建Cox比例风险模型，以估计社交网络类型对每个国家死亡风险的影响，并对社会人口统计学、养老金领取情况、残疾、医疗状况和抑郁进行调整。进行荟萃分析以获得合并估计值。
在中国城市，私人网络类型的患病率为64.4%，在中国农村为1.6%；而在中国城市，本地整合型的患病率为6.6%，在中国农村为86.8%。（a）所有国家和（b）拉丁美洲的调整后合并估计值表明，与本地整合型社交网络类型相比，本地自给自足型（（b）风险比=1.24，95%置信区间1.01-1.51）、家庭依赖型（（a）风险比=1.13，95%置信区间1.01-1.26；（b）风险比=1.13，95%置信区间1.001-1.28）和私人型（（a）风险比=1.36，95%置信区间1.06-1.73；（b）风险比=1.45，95%置信区间1.20-1.75）社交网络类型与较高的死亡风险显著相关。
嵌入受限社交网络（即本地自给自足型、家庭依赖型和私人网络类型）的个体生存时间显著缩短。通过满足那些最易被忽视和健康状况恶化风险最高人群的需求，可能会加强社会护理干预措施。发展中国家的卫生政策制定者可以利用这些信息，通过针对那些嵌入受限社交网络的人群来规划有限资源的有效利用。
