RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd
SP e004124
DO 10.1136/bmjgh-2020-004124
VO 6
IS 3
A1 Ryo Naito
A1 Darryl P Leong
A1 Shrikant Ishver Bangdiwala
A1 Martin McKee
A1 S V Subramanian
A1 Sumathy Rangarajan
A1 Shofiqul Islam
A1 Alvaro Avezum
A1 Karen E Yeates
A1 Scott A Lear
A1 Rajeev Gupta
A1 Afzalhussein Yusufali
A1 Antonio L Dans
A1 Andrzej Szuba
A1 Khalid F Alhabib
A1 Manmeet Kaur
A1 Omar Rahman
A1 Pamela Seron
A1 Rafael Diaz
A1 Thandi Puoane
A1 Weida Liu
A1 Yibing Zhu
A1 Yundong Sheng
A1 Patricio Lopez-Jaramillo
A1 Jephat Chifamba
A1 Ismail Rosnah
A1 Kubilay Karsidag
A1 Roya Kelishadi
A1 Annika Rosengren
A1 Rasha Khatib
A1 Leela Itty Amma K R
A1 Syed Iqbal Azam
A1 Koon Teo
A1 Salim Yusuf
YR 2021
UL http://gh.bmj.com/content/6/3/e004124.abstract
AB 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.