Laustsen L M, Lasgaard M, Momen N C, Chen D, Gradus J L, Grønkjær M S, Jensen M M, Plana-Ripoll O
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark.
Epidemiol Psychiatr Sci. 2024 Dec 23;33:e81. doi: 10.1017/S2045796024000829.
Individuals with diminished social connections are at higher risk of mental disorders, dementia, circulatory conditions and musculoskeletal conditions. However, evidence is limited by a disease-specific focus and no systematic examination of sex differences or the role of pre-existing mental disorders.
We conducted a cohort study using data on social disconnectedness (loneliness, social isolation, low social support and a composite measure) from the 2013 and 2017 Danish National Health Survey linked with register data on 11 broad categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences (IRDs), and explore sex differences and interaction with pre-existing mental disorders.
Among 162,497 survey participants, 7.6%, 3.5% and 14.8% were classified as lonely, socially isolated and with low social support, respectively. Individuals who were lonely and with low social support had a higher incidence rate in all 11 categories of medical conditions (interquartile range [IQR] of IRRs, respectively 1.26-1.49 and 1.10-1.14), whereas this was the case in nine categories among individuals who were socially isolated (IQR of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.63 for a mental disorder (95% confidence interval [CI], 2.38-2.91), corresponding to an IRD of 54 (95% CI, 47-61) cases per 10,000 person-years. We found sex and age differences in some relative and absolute estimates, but no substantial deviations from additive interaction with pre-existing mental disorders.
This study advances our knowledge of the risk of medical conditions faced by individuals who are socially disconnected. In addition to the existing evidence, we found higher incidence rates for a broad range of medical condition categories. Contrary to previous evidence, our findings suggest that loneliness is a stronger determinant for subsequent medical conditions than social isolation and low social support.A preregistered analysis plan and statistical code are available at Open Science Framework (https://osf.io/pycrq).
社会联系减少的个体患精神障碍、痴呆、循环系统疾病和肌肉骨骼疾病的风险更高。然而，现有证据受限于对特定疾病的关注，且缺乏对性别差异或既往精神障碍作用的系统研究。
我们进行了一项队列研究，使用了2013年和2017年丹麦国民健康调查中关于社会脱节（孤独、社会隔离、社会支持不足及一项综合指标）的数据，并将其与截至2021年的11大类疾病的登记数据相联系。采用泊松回归来估计发病率比（IRR）、发病率差异（IRD），并探讨性别差异以及与既往精神障碍的相互作用。
在162,497名调查参与者中，分别有7.6%、3.5%和14.8%的人被归类为孤独、社会隔离和社会支持不足。孤独和社会支持不足的个体在所有11类疾病中的发病率更高（IRR的四分位数间距[IQR]分别为1.26 - 1.49和1.10 - 1.14），而社会隔离的个体在9类疾病中是这种情况（IRR的IQR为1.01 - 1.31）。应用综合指标，精神障碍的最高IRR为2.63（95%置信区间[CI]，2.38 - 2.91），相当于每10,000人年的IRD为54（95% CI，47 - 61）例。我们在一些相对和绝对估计中发现了性别和年龄差异，但与既往精神障碍的相加相互作用没有实质性偏差。
本研究增进了我们对社会脱节个体所面临疾病风险的认识。除现有证据外，我们发现广泛的疾病类别发病率更高。与先前证据相反，我们的研究结果表明，孤独比社会隔离和社会支持不足对后续疾病的影响更大。可在开放科学框架（https://osf.io/pycrq）获取预先注册的分析计划和统计代码。
