Teshale Achamyeleh Birhanu, Htun Htet Lin, Owen Alice J, Baker J R, Isaksen Irja, Freak-Poli Rosanne
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
J Gen Intern Med. 2025 Jun 25. doi: 10.1007/s11606-025-09648-7.
Living alone poses significant cardiovascular disease (CVD) and mortality risks. The population attributable fraction (PAF) quantifies the proportion of disease burden attributable to a specific risk factor. This study aims to estimate the PAF for CVD and all-cause mortality related to living completely alone. Additionally, the study examined the PAFs associated with not living with a partner/spouse.
This study used longitudinal data from the Aspirin in Reducing Events in the Elderly (ASPREE) study and its sub-study, the ASPREE Longitudinal Study of Older Persons (ALSOP), which included 5853 men and 6998 women. The participants were community-dwelling healthy adults aged 70 + years without CVD, dementia, or significant physical disabilities. Adjusting for social determinants and traditional risk factors, the gender-specific PAFs of CVD and all-cause mortality attributable to living completely alone and not living with a partner/spouse were determined.
Among women, 13.5% (95% CI: 6.3%, 22.4%) of CVD events could be attributed to living completely alone, and 14.1% (95% CI: 4.6%, 25.2%) to not living with a partner/spouse. For all-cause mortality in women, the corresponding PAFs were 9.8% (95% CI: 3.7%, 16.6%) and 12.3% (95% CI: 5.8%, 20.8%), respectively. In contrast, among men, only the PAF between not living with a partner/spouse and all-cause mortality reached statistical significance (PAF = 6.0%; 95% CI: 1.7%, 10.2%). The remaining PAF estimates for CVD events and all-cause mortality were not statistically significant.
The observed gender differences in CVD and all-cause mortality related to living alone highlight the need for tailored public health interventions to meet gender-specific needs for social connectedness.
独居会带来重大的心血管疾病（CVD）和死亡风险。人群归因分数（PAF）量化了可归因于特定风险因素的疾病负担比例。本研究旨在估计与完全独居相关的心血管疾病和全因死亡率的PAF。此外，该研究还考察了与未与伴侣/配偶同住相关的PAF。
本研究使用了老年人阿司匹林减少事件（ASPREE）研究及其子研究——ASPREE老年人纵向研究（ALSOP）的纵向数据，其中包括5853名男性和6998名女性。参与者为70岁及以上、居住在社区、无心血管疾病、痴呆或严重身体残疾的健康成年人。在调整社会决定因素和传统风险因素后，确定了完全独居和未与伴侣/配偶同住导致的心血管疾病和全因死亡率的性别特异性PAF。
在女性中，13.5%（95%置信区间：6.3%，22.4%）的心血管疾病事件可归因于完全独居，14.1%（95%置信区间：4.6%，25.2%）可归因于未与伴侣/配偶同住。对于女性的全因死亡率，相应的PAF分别为9.8%（95%置信区间：3.7%，16.6%）和12.3%（95%置信区间：5.8%，20.8%）。相比之下，在男性中，只有未与伴侣/配偶同住与全因死亡率之间的PAF达到统计学显著性（PAF = 6.0%；95%置信区间：1.7%，10.2%）。其余心血管疾病事件和全因死亡率的PAF估计值无统计学显著性。
观察到的与独居相关的心血管疾病和全因死亡率的性别差异凸显了需要制定针对性的公共卫生干预措施，以满足性别特定的社会联系需求。
