National Heart, Lung, and Blood Institutes Framingham Heart Study, Framingham, MA, USA.
Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
Sci Rep. 2022 Mar 10;12(1):3958. doi: 10.1038/s41598-022-07850-9.
Social isolation might be considered as a marker of poor health and higher mortality. The aim of our analysis was to assess the association of social network index (SNI) with incident AF and death. We selected participants aged ≥ 55 years without prevalent AF from the Framingham Heart Study. We evaluated the association between social isolation measured by the Berkman-Syme Social Network Index (SNI), incident AF, and mortality without diagnosed AF. We assessed the risk factor-adjusted associations between SNI (the sum of 4 components: marriage status, close friends/relatives, religious service attendance, social group participation), incident AF, and mortality without AF by using Fine-Gray competing risk regression models. We secondarily examined the outcome of all-cause mortality. We included 3454 participants (mean age 67 ± 10 years, 58% female). During 11.8 ± 5.2 mean years of follow-up, there were 686 incident AF cases and 965 mortality without AF events. Individuals with fewer connections had lower rates of incident AF (P = 0.04) but higher rates of mortality without AF (P = 0.03). Among SNI components, only social group participation was associated with higher incident AF (subdistribution hazards ratio [sHR] 1.35, 95% CI 1.16-1.57, P = 0.0001). For mortality without AF, social group participation (sHR = 0.81, 95% CI 0.71-0.93, P = 0.002) and regular religious service attendance sHR = 0.76, 95% CI 0.67-0.87, P < 0.0001) were associated with lower risk of death. Social isolation was associated with a higher rate of mortality without diagnosed AF. In contrast to our hypothesis, we observed that poor social connectedness was associated with a lower rate of incident AF. This finding should be interpreted cautiously since there were very few participants in the lowest social connectedness group. Additionally, the seemingly protective effect of social isolation on AF incidence may be simply an artifact of the strong association between social isolation and increased mortality rate in combination with the large number of deaths as compared to AF events in our study. Further study is warranted.
社会隔离可能被视为健康状况不佳和死亡率较高的标志。我们分析的目的是评估社会网络指数 (SNI) 与房颤事件和死亡的关系。我们从弗雷明汉心脏研究中选择了年龄≥55 岁且无房颤的参与者。我们评估了社会隔离（由 Berkman-Syme 社会网络指数 (SNI) 衡量）与房颤事件和无诊断性房颤的死亡率之间的关系。我们使用 Fine-Gray 竞争风险回归模型评估了 SNI（婚姻状况、亲密朋友/亲属、参加宗教服务、参加社会团体这 4 个组成部分的总和）与房颤事件和无房颤死亡率之间的风险因素调整关联。我们还检查了全因死亡率的结果。我们纳入了 3454 名参与者（平均年龄 67±10 岁，58%为女性）。在 11.8±5.2 年的平均随访期间，有 686 例房颤事件和 965 例无房颤死亡率事件。连接较少的个体发生房颤的发生率较低（P=0.04），但无房颤死亡率较高（P=0.03）。在 SNI 组成部分中，只有参加社会团体与较高的房颤发生率相关（亚分布危险比 [sHR] 1.35，95%CI 1.16-1.57，P=0.0001）。对于无房颤死亡率，参加社会团体（sHR=0.81，95%CI 0.71-0.93，P=0.002）和定期参加宗教服务（sHR=0.76，95%CI 0.67-0.87，P<0.0001）与死亡风险降低相关。社会隔离与无诊断性房颤死亡率较高相关。与我们的假设相反，我们观察到社交联系较差与房颤事件发生率较低相关。由于在最低社交联系组中参与者非常少，因此应谨慎解释这一发现。此外，社交隔离对房颤发生率的保护作用可能仅仅是社交隔离与死亡率增加之间的强烈关联以及与房颤事件相比我们研究中大量死亡人数相结合的一个假象。需要进一步研究。
