Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Health Behaviour, Environment and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Int J Equity Health. 2020 Jul 31;19(1):128. doi: 10.1186/s12939-020-01238-9.
Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs - including Indonesia - epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes.
Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses.
At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women.
Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.
社交网络（SN）已被证明对健康老龄化至关重要，并成为重要的安全网，特别是对中低收入国家（LMICs）的老年人而言。尽管从 SN 的角度来解释健康结果很重要，但在包括印度尼西亚在内的许多 LMICs 中，关于 SN 对老龄化人口健康影响的流行病学研究和政策反应仍然很少。本研究采用广泛的多方法方法对纵向面板数据进行分析，旨在更清楚地阐明 SN 多样性在印度尼西亚老龄化过程中的作用。我们探讨了 SN 多样性与成年人健康结果之间是否存在关联，以及关联的程度，并调查了潜在的性别差异、异质处理效应和残疾过程中的效应梯度。
数据来自于 2007-08 年和 2014-15 年进行的印度尼西亚家庭生活调查的第四和第五波。分析样本包括 3060 名 50 岁以上的成年人。主要暴露变量是参与者在基线时的 SN 多样性。这是通过社会网络指数（SNI）来衡量的，该指数结合了家庭规模的信息以及与受访者在六种不同角色关系中保持积极联系的一系列社会关系。本研究以残疾过程模型为指导，纳入了 19 项结果（8 种疾病、5 种障碍、4 种功能限制、2 种残疾）进行分析。使用广泛的多变量回归调整（RA）、倾向评分匹配（PSM）和工具变量（IV）分析来评估 SN 多样性对健康的因果效应。
在基线时，60%的受访者的 SNI 较低。RA 和 PSM 模型的结果最为一致，表明在女性中，多样化的 SN 与肺部结果以及上下身功能呈正相关。SNI 较高的男性和女性报告的日常生活活动（ADL）和工具性日常生活活动（IADL）任务受限较少。SNI 较高的女性 C 反应蛋白水平较低。IV 分析结果显示，SNI 对男性和女性的认知功能均呈正相关。
多样化的 SN 带来了广泛的、强烈的和异质的长期健康影响，特别是对老年女性而言。在正式福利保障有限的环境中，干预老年人的 SN 并保障他们获得多样化的网络可以成为人口健康的一项投资，对健康和公共政策具有多方面的影响。
