Encephalopathy Hospital, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China.
The First Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China.
BMC Public Health. 2024 Sep 4;24(1):2403. doi: 10.1186/s12889-024-19835-6.
The association between poor social relationships and post-stroke mortality remains uncertain, and the evidence regarding the relationship between poor social relationships and the risk of stroke is inconsistent. In this meta-analysis, we aim to elucidate the evidence concerning the risk of stroke and post-stroke mortality among individuals experiencing a poor social relationships, including social isolation, limited social networks, lack of social support, and loneliness.
A thorough search of PubMed, Embase, and the Cochrane Library databases to systematically identify pertinent studies. Data extraction was independently performed by two researchers. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either a random-effects or fixed-effects model. Sensitivity analyses were conducted to evaluate the reliability of the results. Random-effects meta-regression was performed to explore the sources of heterogeneity in stroke risk estimates between studies. Assessment for potential publication bias was carried out using Egger's and Begg's tests.
Nineteen studies were included, originating from 4 continents and 12 countries worldwide. A total of 1,675,707 participants contributed to this meta-analysis. Pooled analyses under the random effect model revealed a significant association between poor social relationships and the risk of stroke (OR = 1.30; 95%CI: 1.17-1.44), as well as increased risks for post-stroke mortality (OR = 1.36; 95%CI: 1.07-1.73). Subgroup analyses demonstrated associations between limited social network (OR = 1.52; 95%CI = 1.04-2.21), loneliness (OR = 1.31; 95%CI = 1.13-1.51), and lack of social support (OR = 1.66; 95%CI = 1.04-2.63) with stroke risk. The meta-regression explained 75.21% of the differences in reported stroke risk between studies. Random-effect meta-regression results indicate that the heterogeneity in the estimated risk of stroke may originate from the continent and publication year of the included studies.
Social isolation, limited social networks, lack of social support, and feelings of loneliness have emerged as distinct risk factors contributing to both the onset and subsequent mortality following a stroke. It is imperative for public health policies to prioritize the multifaceted influence of social relationships and loneliness in stroke prevention and post-stroke care.
The protocol was registered on May 1, 2024, on the Prospero International Prospective System with registration number CRD42024531036.
不良社会关系与卒后死亡率之间的关联仍不确定，且有关不良社会关系与卒中风险之间关系的证据也不一致。本荟萃分析旨在阐明个体经历不良社会关系（包括社会隔离、社交网络有限、缺乏社会支持和孤独感）与卒中风险和卒后死亡率之间的关系的证据。
我们全面检索了 PubMed、Embase 和 Cochrane 图书馆数据库，以系统地识别相关研究。两名研究人员独立进行数据提取。使用随机效应或固定效应模型计算合并的比值比（OR）及其 95%置信区间（CI）。进行敏感性分析以评估结果的可靠性。采用随机效应荟萃回归分析来探讨研究间卒中风险估计值的异质性来源。采用 Egger 和 Begg 检验评估潜在的发表偏倚。
共纳入 19 项研究，来自全球 4 大洲的 12 个国家。共有 1675707 名参与者参与了这项荟萃分析。采用随机效应模型的汇总分析显示，不良社会关系与卒中风险（OR=1.30；95%CI：1.17-1.44）以及卒中后死亡率（OR=1.36；95%CI：1.07-1.73）升高显著相关。亚组分析表明，社交网络有限（OR=1.52；95%CI=1.04-2.21）、孤独感（OR=1.31；95%CI=1.13-1.51）和缺乏社会支持（OR=1.66；95%CI=1.04-2.63）与卒中风险相关。荟萃回归解释了研究间报告的卒中风险差异的 75.21%。随机效应荟萃回归结果表明，估计的卒中风险的异质性可能源于纳入研究的大洲和发表年份。
社会隔离、社交网络有限、缺乏社会支持和孤独感已成为导致卒中发病和随后死亡的明确危险因素。公共卫生政策必须优先考虑社会关系和孤独感对卒中预防和卒中后护理的多方面影响。
该方案于 2024 年 5 月 1 日在 Prospero 国际前瞻性系统上注册，注册号为 CRD42024531036。
