Meta-Analysis the Effects of Social Isolation and Loneliness on Cardiovascular Disease and Death in Elderly
DOI:
https://doi.org/10.26911/jepublichealth.2023.08.01.11Abstract
Background: The impact of social isolation and loneliness on health and well-being is recognized globally as a public health problem. Social isolation can be experienced at any age, especially the elderly. This study aims to analyze and estimate the influence of social isolation and loneliness on cardiovascular disease and death in the elderly.
Subjects and Method: The meta-analysis was carried out according to the PRISMA flow chart and the PICO model. P: Elderly, I: Social isolation and loneliness, C: Not social isolation and not lonely, O: Cardiovascular disease and death. Search for articles in this study through databases that include PubMed, Google Scholar, Science Direct and Scopus with keywords "social isolation" AND "loneliness" AND "cardiovascular disease" AND "elderly". “Social isolation” AND “loneliness” AND “mortality” AND “elderly”. Full paper article with cohort design, adjusted Hazard Ratio for effect size, research outcome are cardiovascular disease and death. Analysis was performed using Revman 5.3.
Results: There were 18 articles with cohort designs originating from America, Finland, Canada, Tai-wan, Australia, the United States, Japan, Denmark, Amsterdam, England, Sweden, Jerusalem, Europe with a total of 1,375,816 research samples. A meta-analysis of 13 cohort studies concluded that seniors who were socially isolated had a 1.23 times the risk of developing cardiovascular disease compared to those who were not socially isolated, and the effect was statistically significant (aHR= 1.23; 95% CI= 1.10 to 1.38; p= 0.003). In addition, the elderly who are socially isolated have a risk of dying 1.16 times compared to those who are not socially isolated, and this effect is statistically significant (aHR= 1.16; 95% CI= 1.07 to 1.21; p= 0.003). A meta-analysis of 13 cohort studies concluded that lonely elderly people had a 1.10 times greater risk of developing cardiovascular disease compared to lonely people, and the effect was statistically significant (aHR= 1.10; 95% CI= 1.01 to 1.20; p= 0.003). In addition, lonely elderly people have a risk of dying 1.19 times compared to being lonely, and the effect is statistically significant (aHR= 1.19; 95% CI= 1.02 to 1.39; p= 0.002).
Conclusion: Social isolation and loneliness increase the risk of cardiovascular disease and death in elderly.
Keywords: social isolation, loneliness, cardiovascular, death, elderly.
Correspondence:
Ayu Novita Wulandari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Jawa Tengah. Email: ayunovitawulandari98@gmail.com. Mobile: +6282281301325.
References
AHA/ASA (2013). An Updated Definition of Stroke for the 21st Century. American Heart Association/American Stroke Association.
Cacioppo JT, Cacioppo S, Capitanio JP, Cole SW (2015). The neuroendocrinology of social isolation. Annu Rev Psychol. 66: 733–767. doi: 10.1146/annurevpsych-010814-015240.
Campagne DM (2019). Stress and perceived social isolation (loneliness). Arch Ge-rontol Geriatr. 82: 192–199. Doi:10.1016/j.archger.2019.02.007.
Cene CW, Leng XI, Faraz K, Allison M, Bre-athett K, Bird C, Coday M, et al. (2022). Social isolation and incident heart failure hospitalization in older women: women’s health initiative study findings. J Am Heart Assoc. 11(5): 1–11. doi: 10.1161/JAHA.120.022907.
Conde-Sala JL, Garre-Olmo J, Calvó-Perxas L, Turró-Garriga O, Vilalta-Franch J, López-Pousa S (2020). Causes, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: results from the survey of health, ageing and retirement in europe 2013–2015. Arch Gerontol Geriatr. 89. doi: 10.1016/j.archger.2020.104035.
Christensen AV, Juel K, Ekholm O, Thrysoe L, Thorup CB, Borregaard B, Mols RE, et al. (2020). Significantly increased risk of all-cause mortality among cardiac patients feeling lonely. Heart. 106(2): 140–146. doi: 10.1136/heart-jnl-2019-315460.
Christiansen J, Lund R, Qualter P, Ander-sen CM, Pedersen SS, Lasgaard M (2021). Loneliness, social isolation, and chronic disease outcomes. Ann Behav Med. 55(3): 203–215. doi: 10.1093/abm/kaaa044.
Elovainio M, Hakulinen C, Pulkki-Raback L, Virtanen M, Josefsson K, Jokela M, Vahtera J, et al. (2017). Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. Lancet Glob Health. 2(6): e260–e266. doi: 10.1016/S246-8-2667(17)30075-0.
Foti SA, Khambaty T, Birnbaum-Weitzman, O, Arguelles W, Penedo F, Giacinto RAE, Gutierrez AP, et al. (2020). Loneliness, Cardiovascular Disease, and Diabetes Prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. J Immigrant Minority Health. 22: 345-352. doi: 10.1007/s10903-019-00885-7.
Freak-Poli R, Ryan J, Neumann JT, Tonkin A, Reid CM, Woods RL, Nelson M, et al. (2021). Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality. BMC Geriatr. 21(1): 1–14. doi: 10.1186/s12877-021-02602-2
Gao Q, Prina AM, Prince M, Acosta D, Luisa Sosa A, Guerra M, Huang Y, et al. (2021). Loneliness among older adults in latin america, china, and india: prevalence, correlates and association with mortality. Int J Public Health. 66. doi: 10.3389/ijph.2021.604449.
Gilmour H, Ramage-Morin PL (2020). Social isolation and mortality among Canadian seniors. Health Rep. 31(3): 27–38. doi: 10.25318/82003-x2020-00300003-eng.
Golaszewski NM, Lacroix AZ, Godino JG, Allison MA, Manson JE, King JJ, Weitlauf JC, et al. (2022). Evaluation of social isolation, loneliness, and cardiovascular disease among older women in the us. JAMA Netw Open. 5(2): 1–12. doi: 10.1001/jamanetworkopen.2021.46461.
Hakulinen C, Pulkki-Raback L, Virtanen M, Jokela M, Kivimaki M, Elovainio M (2018). Social isolation and loneliness as risk factors for myocardial infraction, stroke and mortality: UK Biobank cohort study of 479 054 men and women. Heart. 104(18): 1536–1542. doi: 10.1136/heartjnl-2017-312-663.
Henriksen J, Larsen ER, Mattisson C, Andersson NW (2019). Loneliness, health and mortality. Epidemiol Psychiatr Sci. 28(2): 234–239. doi: 10.1017/S2045796017000580.
Hegeman A, Schutter N, Comijs H, Holwerda T, Dekker J, Stek M, van der Mast R (2018). Loneliness and cardiovascular disease and the role of late-life depression. Int J Geriatr Psy-chiatry. 33(1): e65–e72.doi: 10.1002/gps.4716.
Hoogendijk EO, Smit AP, van Dam C, Schu-ster NA, de Breij S, Holwerda TJ, Huis-man M, et al. (2020). Frailty combined with loneliness or social isolation: an elevated risk for mortality in later life. J Am Geriatr Soc. 68(11): 2587–2593. doi: 10.1111/jgs.16716.
Hussain MA, Mamun AAl, Peters SAE, Woodward M, Huxley RR (2016). The burden of cardiovascular disease attributable to major modifiable risk factors in Indonesia. Am J Epidemiol. 26(10): 515–521. doi: 10.2188/jea.JE20150178.
Jumayanti, Anggi LW. EYAB, Sunaryo (2020). Kualitas hidup pasien dengan penyakit, kardiovaskular di yogyakarta. J Kesehat. 13(1): 1–12.
Julsing JE, Kromhout D, Geleijnse JM, Giltay EJ (2016). Loneliness and all-cause, cardiovascular, and noncardiovascular mortality in older men: the zutphen elderly study. Am J Geriatr Psychiatry. 24(6): 475–484. doi: 10.1016/j.jagp.2016.01.136.
Kemenkes RI (2019). Policy paper analisis kebijakan mewujudkan lanjut usia sehat menuju lanjut usia aktif (active ageing), Analisis Determinan Kesehatan. Kementerian Kesehatan Republik Indonesia.
Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Sekine O, Shiraishi Y, et al. (2022). Social isolation and implementation of advanced care planning among hospitalized patients with heart failure. J Am Heart Assoc. 11(21). doi: 10.1161/JAHA.122.026645.
Kotozaki Y, Tanno K, Sakata K, Otsuka K, Sasaki R, Takanashi N, Satoh M, et al. (2022). Association between social isolation and total mortality after the great east japan earthquake in iwate prefecture: findings from the tmm commcohort study. Int J Environ Res Public Health. 19(7). doi: 10.3390/ijerph19074343.
Kraav SL, Awoyemi O, Junttila N, Vorna-nen R, Kauhanen J, Toikko T, Lehto S, et al. (2021). The effects of loneliness and social isolation on all-cause, injury, cancer, and CVD mortality in a cohort of middle-aged Finnish men. A prospective study. Aging Ment Health. 25(12): 2219–2228. doi: 10.-1080/13607863.2020.1830945.
Iecovich E, Jacobs J, Stessman J (2011). Loneliness, social networks, and mortality: 18 years of follow-up. Int J Aging Hum Dev. 72(3): 243–263. doi: 10.2190/AG.72.3.e.
Lee H, Singh GK (2021). Social isolation and all-cause and heart disease mortality among working-age adults in the United States: the 1998-2014 nhis-ndi record linkage study. Health Equity. 5(1): 750–761. doi: 10.1089/heq.2021.0003.
Lee SB, Oh JH, Park JH, Choi SP, Wee JH (2018). Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med. 5(4): 249-255. doi: 10.15441/ceem.17.261.
Luo J, Hendryx M (2022). Mediation analysis of social isolation and mortality by health behaviors. Prev Med. 154. doi: 10.1016/j.ypmed.2021.106881.
Naito R, Leong DP, Bangdiwala SI, McKee M, Subramanian SV, Rangarajan S, Islam S, et al. (2021). Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents. BMJ Glob Health. 6(3). doi: 10.1136/bmjgh-2020-004124.
Novak M, Waern M, Johansson L, Zetter-gren A, Ryden L, Wetterberg H, Gud-mundsson P, et al. (2020). Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women. BMC Geriatr. 20(1): 1–7. doi:10.1186/s12877-020-01603x.
O’Súilleabháin PS, Gallagher S, Steptoe A (2019). Loneliness, living alone, and all-cause mortality: The role of emotional and social loneliness in the elderly during 19 years of follow-up. Psychosom Med. 81(6): 521–526. doi: 10.10-97/PSY.0000000000000710.
Sakurai R, Yasunaga M, Nishi M, Fukaya T, Hasebe M, Murayama Y, Koike T, et al. (2019). Coexistence of social isolation and homebound status increase the risk of all-cause mortality. Int Psychogeriatr. 31(5): 703–711. doi: 10.1017/S1041610218001047.
Schutter N, Holwerda TJ, Comijs HC, Stek ML, Peen J, Dekker JJM (2022). Loneliness, social network size and mortality in older adults: a meta-analysis. Eur J Ageing. 19(4): 1057–1076. doi: 10.1007/s10433-022-00740-z.
Sharma T, Padala PR, Mehta JL (2021). Loneliness and Social Isolation: Determinants of Cardiovascular Outcomes. 17(6): 37-44. doi: 10.2174/157-3403X17666210129101845.
Steptoe A, Shankar A, Demakakos P, Wardle J (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci USA. 110(15): 5797–5801. doi: 10.1073/pnas.1219686110.
Stokes AC, Xie W, Lundberg DJ, Glei DA, Weinstein MA (2021). Loneliness, social isolation, and all-cause mortality in the United States. SSM-Mental Health. 1:100014. doi: 10.1016/j.ssmmh.2021.100014
Tilvis RS, Routasalo P, Karppinen H, Strandberg TE, Kautiainen H, Pitkala KH (2012). Social isolation, social activity and loneliness as survival indicators in old age; A nationwide survey with a 7-year follow-up. Eur Geriatr Med. 3(1): 18–22. doi: 10.1016/j.eurger.2011.08.004.
Wang H, Leng Y, Zhao E, Fleming J, Brayne C (2020). Mortality risk of loneliness in the oldest old over a 10-year follow-up. Aging Ment Health. 24(1): 35–40. doi:10.1080/13607863.2018.1510897.
WHO (2021). Advocacy brief: Social isolation and loneliness among older people. World Health Organization.
WHO (2021). Cardiovascular diseases (CVDs). World Health Organization.
Yang YC, McClintock MK, Kozloski M, Li T (2013). Social Isolation and Adult Mortality: The Role of Chronic Inflammation and Sex Differences. Journal of Health and Social Behavior, 54(2), 183-203. doi: 10.1177/0022146513485244.
Yu B, Steptoe A, Chen LJ, Chen YH, Lin CH, Ku PW (2020). Social isolation, loneliness, and all-cause mortality in patients with cardiovascular disease: A 10-year follow-up study. Psychosom Med. 82: 2. doi: 10.1097/PSY.0000000000000777.
