Social connection and mortality in UK Biobank: a prospective cohort analysis
Abstract Background Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of socia...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-11-01
|
| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-023-03055-7 |
| _version_ | 1797559180335251456 |
|---|---|
| author | Hamish M. E. Foster Jason M. R. Gill Frances S. Mair Carlos A. Celis-Morales Bhautesh D. Jani Barbara I. Nicholl Duncan Lee Catherine A. O’Donnell |
| author_facet | Hamish M. E. Foster Jason M. R. Gill Frances S. Mair Carlos A. Celis-Morales Bhautesh D. Jani Barbara I. Nicholl Duncan Lee Catherine A. O’Donnell |
| author_sort | Hamish M. E. Foster |
| collection | DOAJ |
| description | Abstract Background Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of social connection and mortality. Methods Analysis of 458,146 participants with full data from the UK Biobank cohort linked to mortality registers. Social connection was assessed using two functional (frequency of ability to confide in someone close and often feeling lonely) and three structural (frequency of friends/family visits, weekly group activities, and living alone) component measures. Cox proportional hazard models were used to examine the associations with all-cause and cardiovascular disease (CVD) mortality. Results Over a median of 12.6 years (IQR 11.9–13.3) follow-up, 33,135 (7.2%) participants died, including 5112 (1.1%) CVD deaths. All social connection measures were independently associated with both outcomes. Friends/family visit frequencies < monthly were associated with a higher risk of mortality indicating a threshold effect. There were interactions between living alone and friends/family visits and between living alone and weekly group activity. For example, compared with daily friends/family visits-not living alone, there was higher all-cause mortality for daily visits-living alone (HR 1.19 [95% CI 1.12–1.26]), for never having visits-not living alone (1.33 [1.22–1.46]), and for never having visits-living alone (1.77 [1.61–1.95]). Never having friends/family visits whilst living alone potentially counteracted benefits from other components as mortality risks were highest for those reporting both never having visits and living alone regardless of weekly group activity or functional components. When all measures were combined into overall functional and structural components, there was an interaction between components: compared with participants defined as not isolated by both components, those considered isolated by both components had higher CVD mortality (HR 1.63 [1.51–1.76]) than each component alone (functional isolation 1.17 [1.06–1.29]; structural isolation 1.27 [1.18–1.36]). Conclusions This work suggests (1) a potential threshold effect for friends/family visits, (2) that those who live alone with additional concurrent markers of structural isolation may represent a high-risk population, (3) that beneficial associations for some types of social connection might not be felt when other types of social connection are absent, and (4) considering both functional and structural components of social connection may help to identify the most isolated in society. |
| first_indexed | 2024-03-10T17:40:49Z |
| format | Article |
| id | doaj.art-6de5e4c718e741f19e76129b1c9af4dd |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-10T17:40:49Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-6de5e4c718e741f19e76129b1c9af4dd2023-11-20T09:41:18ZengBMCBMC Medicine1741-70152023-11-0121111710.1186/s12916-023-03055-7Social connection and mortality in UK Biobank: a prospective cohort analysisHamish M. E. Foster0Jason M. R. Gill1Frances S. Mair2Carlos A. Celis-Morales3Bhautesh D. Jani4Barbara I. Nicholl5Duncan Lee6Catherine A. O’Donnell7General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowSchool of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of GlasgowGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowSchool of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of GlasgowGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowSchool of Mathematics and Statistics, The Mathematics and Statistics Building, University of GlasgowGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowAbstract Background Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of social connection and mortality. Methods Analysis of 458,146 participants with full data from the UK Biobank cohort linked to mortality registers. Social connection was assessed using two functional (frequency of ability to confide in someone close and often feeling lonely) and three structural (frequency of friends/family visits, weekly group activities, and living alone) component measures. Cox proportional hazard models were used to examine the associations with all-cause and cardiovascular disease (CVD) mortality. Results Over a median of 12.6 years (IQR 11.9–13.3) follow-up, 33,135 (7.2%) participants died, including 5112 (1.1%) CVD deaths. All social connection measures were independently associated with both outcomes. Friends/family visit frequencies < monthly were associated with a higher risk of mortality indicating a threshold effect. There were interactions between living alone and friends/family visits and between living alone and weekly group activity. For example, compared with daily friends/family visits-not living alone, there was higher all-cause mortality for daily visits-living alone (HR 1.19 [95% CI 1.12–1.26]), for never having visits-not living alone (1.33 [1.22–1.46]), and for never having visits-living alone (1.77 [1.61–1.95]). Never having friends/family visits whilst living alone potentially counteracted benefits from other components as mortality risks were highest for those reporting both never having visits and living alone regardless of weekly group activity or functional components. When all measures were combined into overall functional and structural components, there was an interaction between components: compared with participants defined as not isolated by both components, those considered isolated by both components had higher CVD mortality (HR 1.63 [1.51–1.76]) than each component alone (functional isolation 1.17 [1.06–1.29]; structural isolation 1.27 [1.18–1.36]). Conclusions This work suggests (1) a potential threshold effect for friends/family visits, (2) that those who live alone with additional concurrent markers of structural isolation may represent a high-risk population, (3) that beneficial associations for some types of social connection might not be felt when other types of social connection are absent, and (4) considering both functional and structural components of social connection may help to identify the most isolated in society.https://doi.org/10.1186/s12916-023-03055-7EpidemiologyPublic healthSocial connectionSocial connectionSocial isolationLoneliness |
| spellingShingle | Hamish M. E. Foster Jason M. R. Gill Frances S. Mair Carlos A. Celis-Morales Bhautesh D. Jani Barbara I. Nicholl Duncan Lee Catherine A. O’Donnell Social connection and mortality in UK Biobank: a prospective cohort analysis BMC Medicine Epidemiology Public health Social connection Social connection Social isolation Loneliness |
| title | Social connection and mortality in UK Biobank: a prospective cohort analysis |
| title_full | Social connection and mortality in UK Biobank: a prospective cohort analysis |
| title_fullStr | Social connection and mortality in UK Biobank: a prospective cohort analysis |
| title_full_unstemmed | Social connection and mortality in UK Biobank: a prospective cohort analysis |
| title_short | Social connection and mortality in UK Biobank: a prospective cohort analysis |
| title_sort | social connection and mortality in uk biobank a prospective cohort analysis |
| topic | Epidemiology Public health Social connection Social connection Social isolation Loneliness |
| url | https://doi.org/10.1186/s12916-023-03055-7 |
| work_keys_str_mv | AT hamishmefoster socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT jasonmrgill socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT francessmair socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT carlosacelismorales socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT bhauteshdjani socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT barbarainicholl socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT duncanlee socialconnectionandmortalityinukbiobankaprospectivecohortanalysis AT catherineaodonnell socialconnectionandmortalityinukbiobankaprospectivecohortanalysis |