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

被引：51

作者：

Naito, Ryo ^{[1
,2
,3
]}

Leong, Darryl P. ^{[1
,2
,3
]}

Bangdiwala, Shrikant Ishver ^{[1
,3
,4
]}

McKee, Martin ^{[5
]}

Subramanian, S., V ^{[6
,7
]}

Rangarajan, Sumathy ^{[1
,2
,3
]}

Islam, Shofiqul ^{[1
,2
,3
]}

Avezum, Alvaro ^{[8
]}

Yeates, Karen E. ^{[9
]}

Lear, Scott A. ^{[10
]}

Gupta, Rajeev ^{[11
]}

Yusufali, Afzalhussein ^{[12
]}

Dans, Antonio L. ^{[13
]}

Szuba, Andrzej ^{[14
]}

Alhabib, Khalid F. ^{[15
]}

Kaur, Manmeet ^{[16
]}

Rahman, Omar ^{[17
]}

Seron, Pamela ^{[18
]}

Diaz, Rafael ^{[19
]}

Puoane, Thandi ^{[20
]}

Liu, Weida ^{[21
,22
]}

Zhu, Yibing ^{[23
]}

Sheng, Yundong ^{[24
]}

Lopez-Jaramillo, Patricio ^{[25
]}

Chifamba, Jephat ^{[26
]}

Rosnah, Ismail ^{[27
]}

Karsidag, Kubilay ^{[28
]}

Kelishadi, Roya ^{[29
]}

Rosengren, Annika ^{[30
,31
]}

Khatib, Rasha ^{[32
,33
]}

Amma, Leela Itty K. R. ^{[34
,35
]}

Azam, Syed Iqbal ^{[36
]}

Teo, Koon ^{[1
,2
,3
]}

Yusuf, Salim ^{[1
,2
,3
]}

机构：

[1] Populat Hlth Res Inst, Hamilton, ON, Canada

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] Hamilton Hlth Sci, Hamilton, ON, Canada

[4] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[5] LSHTM, ECOHOST, London, England

[6] Harvard TH Chan Sch Publ Hlth, Harvard Ctr Populat & Dev Studies, Boston, MA USA

[7] Harvard TH Chan Sch Publ Hlth, Dept Soc & Human Dev, Boston, MA USA

[8] Hosp Alemao Oswaldo Cruz, Int Res Ctr, Sao Paulo, Brazil

[9] Queens Univ, Dept Med, Kingston, ON, Canada

[10] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada

[11] Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India

[12] Hatta Hosp, Dubai Med Coll, Dubai Hlth Author, Dubai, U Arab Emirates

[13] Philippine Gen Hosp, Adult Med Res Unit, Manila, Philippines

[14] Wroclaw Med Univ, Dept Angiol Hypertens & Diabetol, Wroclaw, Dolnoslaskie, Poland

[15] King Saud Univ, Coll Med, King Fahad Cardiac Ctr, Dept Cardiac Sci, Riyadh, Saudi Arabia

[16] Postgrad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh, India

[17] Univ Liberal Arts Bangladesh, Dhaka, Dhaka Dist, Bangladesh

[18] Univ La Frontera, Temuco, Chile

[19] ECLA Acad Res Org, Rosario, Argentina

[20] Univ Western Cape, Sch Publ Hlth, Cape Town, Western Cape, South Africa

[21] Peking Union Med Coll, State Key Lab Cardiovasc Dis, Fuwai Hosp, Natl Ctr Cardiovasc Dis, Beijing, Peoples R China

[22] Chinese Acad Med Sci, Beijing, Peoples R China

[23] Chinese Acad Med Sci & Peking Union Med Coll, Beijing, Peoples R China

[24] Jiangxinzhou Community Hlth Serv Ctr, Nanjing, Peoples R China

[25] Univ Santander UDES, Masira Res Inst, Bucaramanga, Colombia

[26] Univ Zimbabwe, Coll Hlth Sci, Dept Physiol, Harare, Zimbabwe

[27] Univ Kebangsaan Malaysia, Community Hlth Dept, Fac Med, Bangi, Malaysia

[28] Istanbul Univ, Div Endocrinol, Med Fac, Fatih, Turkey

[29] Isfahan Univ Med Sci, Cardiovasc Res Inst, Isfahan Cardiovasc Res Ctr, Esfahan, Iran

[30] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Inst Med, Gothenburg, Sweden

[31] Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden

[32] Advocate Aurora Res Inst, Downers Grove, IL USA

[33] Birzeit Univ, Inst Community & Publ Hlth, Birzeit, Palestine

[34] Hlth Action People, Thiruvananthapuram, Kerala, India

[35] Sree Mookambika Inst Med Sci, Dept Community Med, Kulasekharam, India

[36] Aga Khan Univ, Community Hlth Sci CHS Dept, Karachi, Pakistan

来源：

BMJ GLOBAL HEALTH | 2021年 / 6卷 / 03期

基金：

英国医学研究理事会; 新加坡国家研究基金会; 加拿大健康研究院; 瑞典研究理事会;

关键词：

public health; CORONARY-HEART-DISEASE; RISK-FACTORS; OLDER-PEOPLE; LONELINESS; HEALTH; INTEGRATION; SUPPORT; STROKE; COHORT; WINTER;

D O I：

10.1136/bmjgh-2020-004124

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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.

引用

页数：11

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