König Hans-Helmut, Hajek André
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Health Qual Life Outcomes. 2024 Dec 20;22(1):110. doi: 10.1186/s12955-024-02329-9.
Social isolation and loneliness are highly prevalent and may have a negative impact on health-related quality of life (HRQL). The EQ-5D-5L is a widely used questionnaire from which an index value for HRQL based on societal preferences (utility) can be derived. The purpose of this study was to estimate the loss in utility (i.e. disutility) associated with loneliness and social isolation in the German adult population.
Data came from a quota sample of individuals aged 18-74 years residing in Germany (n = 5,000) and representing the adult population in terms of age groups, gender and geographic locations. Data collection was conducted online in August and September 2023 by a certified market research firm. The EQ-5D-5L index score based on the German value set was used as outcome. Moreover, the established Lubben Social Network Scale was used to measure social isolation. The De Jong Gierveld tool was used to quantify loneliness. Groups affected by social isolation or loneliness were compared to non-affected groups, respectively. Differences in covariates between affected and non-affected groups were balanced using entropy balancing. Linear regressions were conducted afterwards (using the weights derived from the entropy balancing). Subgroup analyses by sex and age groups as well as various robustness checks were conducted.
The EQ-5D-5L index score was lower among individuals with social isolation compared to individuals without social isolation (β=-0.04, p < 0.001). Moreover, the EQ-5D-5L index score was lower among individuals with loneliness compared to individuals without loneliness (β=-0.07, p < 0.001). Several robustness checks produced similar results. The findings were almost the same for both women and men and varied only slightly between age groups.
We found a statistically significant and relevant disutility associated with social isolation and, even more pronounced, with loneliness. The magnitude of disutilities is similar to those reported for various chronic diseases. Taking into account the high prevalence of social isolation and, in particular, loneliness, the associated burden in terms of quality-adjusted life years (QALY) lost is likely to be tremendous. The results underline the need to take action against the high prevalence of loneliness and social isolation.
社会孤立和孤独现象极为普遍，可能会对健康相关生活质量（HRQL）产生负面影响。EQ-5D-5L是一种广泛使用的调查问卷，据此可以得出基于社会偏好（效用）的HRQL指数值。本研究的目的是估计德国成年人群中与孤独和社会孤立相关的效用损失（即负效用）。
数据来自居住在德国的18 - 74岁个体的配额样本（n = 5000），在年龄组、性别和地理位置方面代表成年人群体。数据收集于2023年8月和9月由一家经过认证的市场研究公司在线进行。基于德国价值集的EQ-5D-5L指数得分用作结果变量。此外，使用既定的鲁本社会网络量表来测量社会孤立。使用德容·吉尔维尔德工具来量化孤独感。分别将受社会孤立或孤独影响的组与未受影响的组进行比较。使用熵平衡法平衡受影响组和未受影响组之间协变量的差异。之后进行线性回归（使用从熵平衡中得出的权重）。进行了按性别和年龄组的亚组分析以及各种稳健性检验。
与没有社会孤立的个体相比，有社会孤立的个体的EQ-5D-5L指数得分更低（β = -0.04，p < 0.001）。此外，与没有孤独感的个体相比，有孤独感的个体的EQ-5D-5L指数得分更低（β = -0.07，p < 0.001）。多项稳健性检验得出了相似的结果。男性和女性的研究结果几乎相同，年龄组之间的差异仅略有不同。
我们发现与社会孤立相关，甚至更明显地与孤独相关，存在统计学上显著且相关的负效用。负效用的程度与各种慢性病报告的程度相似。考虑到社会孤立尤其是孤独的高患病率，在质量调整生命年（QALY）损失方面的相关负担可能是巨大的。结果强调了针对孤独和社会孤立的高患病率采取行动的必要性。
