TY - JOUR T1 - Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004124 VL - 6 IS - 3 SP - e004124 AU - Ryo Naito AU - Darryl P Leong AU - Shrikant Ishver Bangdiwala AU - Martin McKee AU - S V Subramanian AU - Sumathy Rangarajan AU - Shofiqul Islam AU - Alvaro Avezum AU - Karen E Yeates AU - Scott A Lear AU - Rajeev Gupta AU - Afzalhussein Yusufali AU - Antonio L Dans AU - Andrzej Szuba AU - Khalid F Alhabib AU - Manmeet Kaur AU - Omar Rahman AU - Pamela Seron AU - Rafael Diaz AU - Thandi Puoane AU - Weida Liu AU - Yibing Zhu AU - Yundong Sheng AU - Patricio Lopez-Jaramillo AU - Jephat Chifamba AU - Ismail Rosnah AU - Kubilay Karsidag AU - Roya Kelishadi AU - Annika Rosengren AU - Rasha Khatib AU - Leela Itty Amma K R AU - Syed Iqbal Azam AU - Koon Teo AU - Salim Yusuf Y1 - 2021/03/01 UR - http://gh.bmj.com/content/6/3/e004124.abstract N2 - 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. ER -