Population Health Research Institute, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
BMJ Glob Health. 2021 Mar;6(3). doi: 10.1136/bmjgh-2020-004124.
To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries.
Population-based prospective observational study.
Urban and rural communities in 20 high income, middle income and low income.
119 894 community-dwelling middle-aged adults.
Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases.
Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association.
Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.
研究高、中、低收入国家城市和农村社区中年人群体的社会隔离与死亡率和疾病发病的关系。
基于人群的前瞻性观察研究。
高、中、低收入 20 个国家的城市和农村社区。
119894 名居住在社区的中年成年人。
社会隔离与死亡率、心血管死亡、非心血管死亡和疾病发病的关系。
与低收入国家相比，社会隔离在中高收入国家更为常见，在城市地区比在农村地区更为常见，在老年人和女性中更为常见，在受教育程度较低和失业人群中更为常见。社会隔离在吸烟者和饮食较差者中更为常见。社会隔离与死亡率增加相关（HR 为 1.26，95%CI：1.17 至 1.36），与中风发病（HR：1.23，95%CI：1.07 至 1.40）、心血管疾病（HR：1.15，95%CI：1.05 至 1.25）和肺炎（HR：1.22，95%CI：1.09 至 1.37）发病相关，但与癌症无关。在高、中、低收入国家的人群中，社会隔离与死亡率之间的相关性是一致的（HR（95%CI）：1.69（1.32 至 2.17）、1.27（1.15 至 1.40）和 1.47（1.25 至 1.73），交互作用 p=0.02）。与女性相比，男性和年轻人的社会隔离相关风险更高。对社会隔离与死亡率之间的关联进行中介分析显示，不健康行为和合并症可能占关联的五分之一左右。
社会隔离与不同经济水平国家的死亡率增加相关。许多国家的人口中老年人比例不断增加，这就需要制定有针对性的策略来减轻其不利影响。
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