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Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents

Naito R 1 , Leong DP 1 , Bangdiwala SI 1 , McKee M 2 , Subramanian SV 3 , Rangarajan S 1 Show all authors , Islam S 1 , Avezum A 4 , Yeates KE 5 , Lear SA 6 , Gupta R 7 , Yusufali A 8 , Dans AL 9 , Szuba A 10 , Alhabib KF 11 , Kaur M 12 , Rahman O 13 , Seron P 14 , Diaz R 15 , Puoane T 16 , Liu W 17 , Zhu Y 18 , Sheng Y 19 , Lopez-Jaramillo P 20 , Chifamba J 21 , Rosnah I 22 , Karsidag K 23 , Kelishadi R 24 , Rosengren A 25 , Khatib R 26 , K R LIA 27 , Azam SI 28 , Teo K 1 , Yusuf S 29

Affiliations 

  • 1 Population Health Research Institute, Hamilton, Ontario, Canada
  • 2 ECOHOST, LSHTM, London, UK
  • 3 Harvard Center for Population and Development Studies and Department of Society and Human Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  • 4 International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • 5 Department of Medicine, Queen's University, Kingston, Ontario, Canada
  • 6 Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
  • 7 Eternal Heart Care Centre & Research Institute, Jaipur, India
  • 8 Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, UAE
  • 9 Adult Medicine Research Unit, Philippine General Hospital, Manila, Philippines
  • 10 Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
  • 11 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 12 School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • 13 University of Liberal Arts Bangladesh, Dhaka, Dhaka District, Bangladesh
  • 14 Universidad de La Frontera, Temuco, Chile
  • 15 ECLA - Academic Research Organization, Rosario, Argentina
  • 16 School of Public Health, University of Western Cape, Cape Town, Western Cape, South Africa
  • 17 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Xicheng District, Beijing, China
  • 18 Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
  • 19 Jiangxinzhou Community Health Service Center, Nanjing, China
  • 20 Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia
  • 21 Department of Physiology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
  • 22 Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia, Malaysia
  • 23 Division of Endocrinology, Medical Faculty of Istanbul University, Fatih, Turkey
  • 24 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 25 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
  • 26 Advocate Aurora Research Institute, Downers Grove, Illinois, USA
  • 27 Health Action by People, Thiruvananthapuram, Kerala, India
  • 28 Community Health Sciences (CHS) department, The Aga Khan University, Karachi, Pakistan
  • 29 Population Health Research Institute, Hamilton, Ontario, Canada yusufs@mcmaster.ca
BMJ Glob Health, 2021 03;6(3).
PMID: 33753400 DOI: 10.1136/bmjgh-2020-004124

Abstract

OBJECTIVE: To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries.

DESIGN: Population-based prospective observational study.

SETTING: Urban and rural communities in 20 high income, middle income and low income.

PARTICIPANTS: 119 894 community-dwelling middle-aged adults.

MAIN OUTCOME MEASURES: Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases.

RESULTS: Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association.

CONCLUSION: Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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