Rural Health Research Center, University of Minnesota School of Public Health, Division of Health Policy and Management, Minneapolis, Minnesota.
J Rural Health. 2019 Sep;35(4):540-549. doi: 10.1111/jrh.12344. Epub 2019 Jan 4.
Social isolation is an urgent threat to public health. Meanwhile, health outcomes across multiple measures are worse in rural areas, where distance to neighbors is often greater and opportunities for social interaction may be scarcer. Still, very little research examines rural-urban differences in social isolation. This study addresses that gap by examining differences in social isolation by rurality among US older adults.
Using Wave 2 of the National Social Life, Health, and Aging Project data (n = 2,439), we measured differences between urban and rural (micropolitan or noncore) residents across multiple dimensions of social isolation. We also conducted multivariable analysis to assess the associations between rurality, sociodemographic characteristics, and loneliness, overall and by rurality. Finally, we conducted multivariable analysis to assess the association between social isolation and self-rated health, adjusting for rurality.
Compared to urban residents, rural residents had more social relationships and micropolitan rural residents were more likely to be able to rely on family members (95.8% vs 91.3%, P < .05). Micropolitan rural residents reported lower rates of loneliness than urban residents after adjusting for sociodemographic and health characteristics (b = -0.32, P < .05), whereas noncore rural, non-Hispanic black residents had a greater likelihood of reporting loneliness (b = 4.33, P < .001).
Overall, noncore and micropolitan rural residents reported less social isolation and more social relationships than urban residents. However, there were differences by race and ethnicity among rural residents in perceived loneliness. Policies and programs to address social isolation should be tailored by geography and should account for within-rural differences in risk factors.
社会孤立是对公众健康的一个紧迫威胁。与此同时，在距离邻居通常更远、社交互动机会可能更少的农村地区，多项健康指标的结果更差。尽管如此，很少有研究调查农村和城市地区社会孤立的差异。本研究通过考察美国老年人的农村和城市地区在社会孤立方面的差异来填补这一空白。
使用全国社会生活、健康和老龄化项目第二波数据（n=2439），我们衡量了城市和农村（小城市或非核心城市）居民在多个社会孤立维度上的差异。我们还进行了多变量分析，以评估农村、社会人口特征与孤独感之间的关联，以及农村和城市地区的关联。最后，我们进行了多变量分析，以评估社会孤立与自我评估健康之间的关联，同时调整了农村地区的因素。
与城市居民相比，农村居民拥有更多的社会关系，而小城市农村居民更有可能依靠家庭成员（95.8%对 91.3%，P<.05）。在调整了社会人口特征和健康特征后，小城市农村居民的孤独感报告率低于城市居民（b=-0.32，P<.05），而非核心农村、非西班牙裔黑人居民的孤独感报告率更高（b=4.33，P<.001）。
总体而言，非核心和小城市农村居民比城市居民报告的社会孤立程度较低，社会关系更多。然而，农村居民在孤独感方面存在种族和族裔差异。解决社会孤立问题的政策和方案应根据地理位置进行调整，并应考虑农村地区风险因素的内部差异。
