Division of Pulmonary, Allergy, and Critical Care Medicine.
Division of Pulmonary, Allergy, and Critical Care Medicine, Center for Palliative and Supportive Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama; and.
Ann Am Thorac Soc. 2023 Dec;20(12):1709-1717. doi: 10.1513/AnnalsATS.202304-288OC.
Social isolation and loneliness are gaining recognition for their role in health outcomes, yet they have not been defined in people with chronic obstructive pulmonary disease (COPD). To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD. This is a cross-sectional study of community-dwelling adults aged ⩾50 years in the nationally representative HRS (Health and Retirement Study) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: ) no COPD; ) COPD; and ) COPD on oxygen. Social isolation was defined using a nine-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-Item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both. Participants ( = 10,384) were on average 68 years old (standard deviation, ±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%; COPD: 16%; COPD on oxygen: 20%; < 0.05) and loneliness (no COPD: 11%; COPD: 18%; COPD on oxygen: 22%; < 0.001). In those with COPD, characteristics associated with social isolation ( < 0.05) included sex (men: 22%; women: 13%), non-Hispanic White ethnicity (White: 19%; Black: 7%), low net worth (<$6,000: 32%; $81,001-$239,000: 10%), depression (depression: 24%; no depression: 14%), having difficulty with one or more activities of daily living (one or more difficulty: 22%; no difficulty: 14%), and current cigarette use (current: 24%; never: 13%). Characteristics associated with loneliness ( < 0.05) included younger age (50-64 yr: 22%; 75-84 yr: 12%), being single (single: 32%; married: 12%), depression (depression: 36%; no depression: 13%), having difficulty with one or more activities of daily living (one or more difficulty: 29%; no difficulty: 15%), diabetes (diabetes: 26%; no diabetes: 17%), and heart disease (heart disease 23%; no heart disease: 17%). Nearly one in six adults with COPD experience social isolation, and one in five experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared with the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions.
社交孤立和孤独感越来越受到重视，因为它们与健康结果有关，但在慢性阻塞性肺疾病（COPD）患者中尚未对其进行定义。本研究旨在确定 COPD 患者中社交孤立和孤独感的全国流行情况及其相关特征。这是一项对全国代表性健康与退休研究（HRS）（2016-2018 年）中年龄 ⩾50 岁的社区居住成年人的横断面研究。参与者自我报告 COPD 和补充氧气的使用情况，并分为三组：）无 COPD；）COPD；和）COPD 吸氧。社交孤立采用了一个由九项指标组成的量表来确定，这些指标包括最低限度的家庭接触、社会网络互动和社区参与。孤独感采用 UCLA 孤独感量表的三个项目进行衡量。多变量逻辑回归确定了两者的患病率和相关特征。参与者（ =10384）平均年龄为 68 岁（标准差，±10.5），54%为女性，10%为黑人，11%自我报告患有 COPD，2%自我报告使用补充氧气。总体而言，12%的人存在社交孤立，12%的人感到孤独，3%的人同时存在社交孤立和孤独。患有 COPD 的人社交孤立的调整后患病率更高（无 COPD：11%；COPD：16%；COPD 吸氧：20%； <0.05）和孤独感（无 COPD：11%；COPD：18%；COPD 吸氧：22%； <0.001）。在患有 COPD 的患者中，与社交孤立相关的特征（ <0.05）包括性别（男性：22%；女性：13%）、非西班牙裔白人种族（白人：19%；黑人：7%）、净资产低（<$6000：32%；$81001-$239000：10%）、抑郁（抑郁：24%；无抑郁：14%）、存在一项或多项日常生活活动困难（一项或多项困难：22%；无困难：14%）和当前吸烟（当前吸烟：24%；从不吸烟：13%）。与孤独感相关的特征（ <0.05）包括年龄较小（50-64 岁：22%；75-84 岁：12%）、单身（单身：32%；已婚：12%）、抑郁（抑郁：36%；无抑郁：13%）、存在一项或多项日常生活活动困难（一项或多项困难：29%；无困难：15%）、糖尿病（糖尿病：26%；无糖尿病：17%）和心脏病（心脏病：23%；无心脏病：17%）。近六分之一的 COPD 患者存在社交孤立，五分之一的患者感到孤独，与一般人群相比，吸氧患者的患病率几乎高出两倍。人口统计学和临床特征确定了处于最高风险的人群，以指导临床和政策干预。
