Lee Harold H, Chen Ruijia, Okuzono Sakurako S, Kubzansky Laura D
Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
Int J Epidemiol. 2025 Apr 12;54(3). doi: 10.1093/ije/dyaf050.
We investigated the relationship between loneliness and cardiovascular disease (CVD) in older adults from the USA and South Korea. We conducted counterfactual mediation analyses to explore the potential mediation of this relationship by health behaviors.
We used the Health and Retirement Study (HRS; n = 13 073) from the USA and the Korean Longitudinal Study of Aging (KLoSA; n = 8311) from South Korea. In both cohorts, baseline loneliness was assessed using one item from the Center for Epidemiologic Studies Depression Scale. Incident CVD was defined as reporting new-onset CVD on the biennial questionnaire or CVD death reported by proxies. Within each cohort, we estimated adjusted hazard ratios (aHRs) of incident CVD according to loneliness (yes/no) over 12-14 years of follow-up, adjusting for baseline covariates: social isolation, sociodemographic factors, health conditions, and health behaviors.
Feeling lonely was associated with an increased likelihood of developing CVD in the USA (aHR: 1.15, 95% CI: 1.04, 1.27) and South Korea (aHR: 1.16, 95% CI: 1.00, 1.34). Several behaviors accounted for a proportion of the association: physical activity (14.3%, P = 0.03 in HRS; 1.3%, P = 0.04 in KLoSA) and alcohol (3.9%, P < 0.001 in HRS; 1.3%, P < 0.001 in KLoSA) in both countries, smoking only in HRS (4.7%, P < 0.001).
The magnitude of the impact of loneliness on CVD was similar in both countries, but behavioral pathways differed. Loneliness may be a risk factor for CVD regardless of culture; however, different prevention strategies in clinical settings may be required.
我们研究了美国和韩国老年人孤独感与心血管疾病（CVD）之间的关系。我们进行了反事实中介分析，以探讨健康行为对这种关系的潜在中介作用。
我们使用了来自美国的健康与退休研究（HRS；n = 13073）和来自韩国的韩国老年纵向研究（KLoSA；n = 8311）。在这两个队列中，使用流行病学研究中心抑郁量表中的一个项目评估基线孤独感。新发CVD被定义为在两年一次的问卷中报告新发CVD或由代理人报告的CVD死亡。在每个队列中，我们根据12 - 14年随访期间的孤独感（是/否）估计新发CVD的调整后风险比（aHRs），并对基线协变量进行调整：社会隔离、社会人口学因素、健康状况和健康行为。
在美国（aHR：1.15，95%CI：1.04，1.27）和韩国（aHR：1.16，95%CI：1.00，1.34），感到孤独与患CVD的可能性增加有关。几种行为在这种关联中占一定比例：在两个国家中，身体活动（美国HRS中占14.3%，P = 0.03；韩国KLoSA中占1.3%，P = 0.04）和饮酒（美国HRS中占3.9%，P < 0.001；韩国KLoSA中占1.3%，P < 0.001），仅在美国HRS中吸烟占（4.7%，P < 0.001）。
孤独感对CVD的影响程度在两个国家相似，但行为途径不同。无论文化如何，孤独感可能都是CVD的一个危险因素；然而，临床环境中可能需要不同的预防策略。
