Soh Yenee, Kawachi Ichiro, Kubzansky Laura D, Berkman Lisa F, Tiemeier Henning
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Harvard Center for Population and Development Studies, Cambridge, MA, USA.
EClinicalMedicine. 2024 Jun 24;73:102639. doi: 10.1016/j.eclinm.2024.102639. eCollection 2024 Jul.
Loneliness has been implicated as a stroke risk factor, yet studies have examined loneliness at only one time point. The association of loneliness changes and risk of incident stroke remains understudied. Our aim was to examine the association of loneliness with incident stroke, particularly the role of loneliness chronicity.
This prospective cohort study examined data from the Health and Retirement Study during 2006-2018. For analyses examining baseline loneliness only, we included U.S. adults aged 50 years or older and stroke-free at baseline and excluded individuals missing data on loneliness and those who experienced death at baseline. For analyses examining loneliness changes over two time points, we included those aged 50 years or older at baseline and stroke-free through the exposure measurement period. Individuals missing a loneliness scale measure or those who experienced death during the exposure measurement period were excluded. Loneliness was measured with the 3-item Revised UCLA Loneliness Scale. We constructed loneliness scores (range 3-9), dichotomized loneliness measures (high vs low using a >6 cutoff), and loneliness patterns across two time points (consistently low, remitting, recent onset, consistently high). Cox regression models estimated associations of baseline loneliness (N = 12,161) with incident stroke over a 10-12-year period, and loneliness change patterns (N = 8936) with incident stroke over a subsequent 6-8-year period, adjusting for demographics, health behaviors and health conditions.
Higher loneliness scores at baseline were associated with incident stroke for continuous (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.01-1.08) and dichotomized (HR: 1.25, 95% CI: 1.06-1.47) loneliness measures, and persisted after adjustment for social isolation but not depressive symptoms. Only individuals with a consistently high loneliness pattern over time (vs consistently low) had significantly higher incident stroke risk (HR: 1.56, 95% CI: 1.11-2.18) after adjusting for depressive symptoms and social isolation.
Chronic loneliness was associated with higher stroke risk independent of depressive symptoms or social isolation. Addressing loneliness may have an important role in stroke prevention, and repeated assessments of loneliness over time may help identify those particularly at risk.
National Institute on Aging (NIA U01AG009740).
孤独已被认为是中风的一个风险因素，但以往研究仅在一个时间点考察孤独情况。孤独感变化与首次中风风险之间的关联仍未得到充分研究。我们的目的是研究孤独与首次中风的关联，尤其是孤独的慢性特征所起的作用。
这项前瞻性队列研究分析了2006年至2018年健康与退休研究的数据。对于仅考察基线孤独感的分析，我们纳入了年龄在50岁及以上、基线时无中风的美国成年人，并排除了孤独感数据缺失者以及在基线时死亡的个体。对于考察两个时间点孤独感变化的分析，我们纳入了基线时年龄在50岁及以上、在暴露测量期内无中风的个体。排除了孤独感量表测量数据缺失者或在暴露测量期内死亡的个体。孤独感采用3项修订版加州大学洛杉矶分校孤独量表进行测量。我们构建了孤独感得分（范围为3 - 9）、孤独感测量指标二分法（以>6为界分为高与低）以及两个时间点的孤独感模式（持续低、缓解、近期起病、持续高）。Cox回归模型估计了基线孤独感（N = 12161）与10 - 12年期间首次中风的关联，以及孤独感变化模式（N = 8936）与随后6 - 8年期间首次中风的关联，并对人口统计学、健康行为和健康状况进行了调整。
对于连续性孤独感测量指标（风险比[HR]：1.05，95%置信区间[CI]：1.01 - 1.08）和二分法孤独感测量指标（HR：1.25，95% CI：1.06 - 1.47），基线时较高的孤独感得分与首次中风相关，在调整社会隔离因素后该关联仍然存在，但调整抑郁症状后则不然。仅那些随着时间推移孤独感模式持续高（与持续低相比）的个体，在调整抑郁症状和社会隔离因素后，首次中风风险显著更高（HR：1.56，95% CI：1.11 - 2.18）。
慢性孤独与较高的中风风险相关，独立于抑郁症状或社会隔离因素。解决孤独问题可能在中风预防中发挥重要作用，随着时间对孤独感进行反复评估可能有助于识别那些尤其有风险的个体。
美国国立衰老研究所（NIA U01AG009740）
