Cerhan J R, Wallace R B
Department of Preventive Medicine and Environmental Health, University of Iowa College of Medicine, Iowa City, 52242-1008, USA.
Epidemiology. 1997 Sep;8(5):475-81. doi: 10.1097/00001648-199709000-00001.
Prior studies assessing social ties and mortality risk in older persons have not considered the dynamic nature of social ties, health, and functional status in this age group. We evaluated the association between change in social ties (assessed in 1982 and 1985) and subsequent mortality through 1993 in a population-based cohort of 2,575 rural persons ages 65-102 years. The same summary measure of social ties was constructed for both interviews and included marital status, number of close friends and relatives, church attendance, and membership in a group. Compared with persons reporting higher levels of social ties at both interviews, a decrease to a low level of social ties was associated with an increased mortality risk for both men [hazard ratio (HR) = 1.8; 95% confidence interval (CI) = 1.2-2.7] and women (HR = 2.1; 95% CI = 1.5-3.0). Lower levels of social ties at both interviews were also associated with greater mortality risk in men (HR = 2.2: 95% CI = 1.5-3.1) and women (HR = 2.2; 95% CI = 1.6-2.9), whereas an increase to a higher level of social ties was not associated with subsequent mortality risk. Adjustment for age, education, smoking status, cognitive function, onset of a major illness, change in physical function, change in self-perceived health status, and change in depressive symptoms eliminated the association between loss of social ties and survival, but both men (HR = 2.3; 95% CI = 1.5-3.5) and women (HR = 1.8; 95% CI = 1.2-2.6) reporting low levels of social ties at both interviews remained at elevated risk. The lack of an association between loss of social ties and mortality risk after adjusting for demographic, health, and functional status variables indicates that these are either confounding or intervening variables in a social ties and mortality association. In contrast, sustained low levels of social ties appear to influence mortality risk independent of these same variables and imply that continued social isolation may be a more important determinant of mortality risk than recent changes in social ties.
此前评估老年人社会关系与死亡风险的研究，尚未考虑该年龄组中社会关系、健康及功能状态的动态性质。我们在一个基于人群的队列中，对2575名年龄在65至102岁的农村居民进行了评估，以研究1982年和1985年评估的社会关系变化与截至1993年的后续死亡率之间的关联。两次访谈均构建了相同的社会关系汇总指标，包括婚姻状况、亲密朋友和亲属的数量、去教堂做礼拜的情况以及团体成员身份。与在两次访谈中报告社会关系水平较高的人相比，社会关系降至低水平与男性[风险比（HR）=1.8；95%置信区间（CI）=1.2 - 2.7]和女性（HR = 2.1；95% CI = 1.5 - 3.0）的死亡风险增加相关。两次访谈中社会关系水平较低也与男性（HR = 2.2：95% CI = 1.5 - 3.1）和女性（HR = 2.2；95% CI = 1.6 - 2.9）更高的死亡风险相关，而社会关系升至更高水平与后续死亡风险无关。对年龄、教育程度、吸烟状况、认知功能、重大疾病发病情况、身体功能变化、自我感知健康状况变化以及抑郁症状变化进行调整后，消除了社会关系丧失与生存之间的关联，但在两次访谈中报告社会关系水平较低的男性（HR = 2.3；95% CI = 1.5 - 3.5）和女性（HR = 1.8；95% CI = 1.2 - 2.6）仍处于较高风险中。在调整了人口统计学、健康和功能状态变量后，社会关系丧失与死亡风险之间缺乏关联，这表明这些变量在社会关系与死亡关联中要么是混杂变量，要么是干预变量。相比之下，持续的低水平社会关系似乎独立于这些相同变量影响死亡风险，这意味着持续的社会隔离可能比近期社会关系变化更重要地决定死亡风险。
