Zhao Meng, Huo Xiaoyang, Zhang Haihong, Wu Chen, Peng Sijing, Liu Zuyun, Sha Sha, Li Ming, Wang Kefang
School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, China.
BMC Public Health. 2025 Jul 18;25(1):2499. doi: 10.1186/s12889-025-23708-x.
Globally, one-third of older adults experience social isolation or loneliness, making them critical public health priorities. However, the impact of social isolation and loneliness on life expectancy remains underexplored. This study investigated the separate and joint associations of social isolation and loneliness with residual life expectancy at age 45 years, alongside the sex-specific variations in these associations with the aim of informing targeted strategies for mitigating social health disparities in rapidly ageing populations.
This prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study. A total of 11,315 community dwellers (5,274 men; 6,041 women) aged 45 years and above included. After the baseline 2011 assessment year, participants from the 2013, 2015, 2018, and 2020 waves were followed up. The measurements included the following: social isolation, assessed on the basis of social network usage, activities, and engagements; loneliness, evaluated on the basis of the subjective feeling of loneliness; and a flexible parametric Royston-Parmar model to estimate hazard ratios (HR) for all-cause mortality and to predict residual life expectancy differences.
In men, socially isolated and lonely individuals had the greatest reduction in residual life expectancy at age 45 years, losing 4.61 years (95% CI: 1.49-7.74) compared to those with neither experience. Social isolation alone (3.82 years lost) and loneliness alone (2.83 years lost) resulted in significant reductions. In women, social isolation alone was significantly associated with reduced residual life expectancy (3.11 years lost, 95% CI: 0.68-5.55), whereas loneliness alone and combined exposure did not show statistically significant effects.
Significant sex-specific differences were identified in the impact of social isolation and loneliness on residual life expectancy. Thus, implementing sex-specific public health strategies that focus on dual psychosocial intervention for men and social integration for women is crucial to mitigate premature deaths in ageing populations.
在全球范围内，三分之一的老年人经历过社会隔离或孤独，这使他们成为重要的公共卫生优先事项。然而，社会隔离和孤独对预期寿命的影响仍未得到充分研究。本研究调查了社会隔离和孤独与45岁时剩余预期寿命的单独及联合关联，以及这些关联中的性别差异，旨在为缓解快速老龄化人口中的社会健康差距制定有针对性的策略提供依据。
本前瞻性队列研究使用了中国健康与养老追踪调查的数据。共纳入11315名45岁及以上的社区居民（5274名男性；6041名女性）。在2011年基线评估年后，对2013年、2015年、2018年和2020年随访的参与者进行了跟踪。测量内容包括：基于社交网络使用、活动和参与情况评估的社会隔离；基于孤独主观感受评估的孤独感；以及用于估计全因死亡率风险比（HR）和预测剩余预期寿命差异的灵活参数罗伊斯顿-帕尔马模型。
在男性中，经历过社会隔离和孤独的个体在45岁时剩余预期寿命下降幅度最大，与既无社会隔离也无孤独感的个体相比，减少了4.61年（95%置信区间：1.49 - 7.74）。仅社会隔离（减少3.82年）和仅孤独感（减少2.83年）都会导致显著下降。在女性中，仅社会隔离与剩余预期寿命下降显著相关（减少3.11年，95%置信区间：0.68 - 5.55），而仅孤独感以及同时经历社会隔离和孤独感并未显示出统计学上的显著影响。
在社会隔离和孤独对剩余预期寿命的影响方面发现了显著的性别差异。因此，实施针对性别的公共卫生策略，即针对男性进行双重心理社会干预，针对女性进行社会融合，对于减少老龄化人口中的过早死亡至关重要。
