Abstract
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Background
Subjective and objective measures of isolation have been associated with increased risk of mortality in many studies, and some have found differential effects.
Data and methods
Canadian Community Health Survey-Healthy Aging data (2008/2009) linked to the Canadian Vital Statistics—Death Database were used to estimate the prevalence of social isolation measured objectively (low social participation) and subjectively (feelings of loneliness and weak sense of community belonging). Associations with death during the 8 to 9 year follow-up period were examined with multivariate Cox proportional hazards models controlling for sociodemographic and health-related characteristics. Structural equation models (SEM) examined direct paths with survival time and indirect effects through health status controlling for covariates that were significant in the Cox models. Analyses were stratified by sex.
Results
An estimated 525,000 people (12%) aged 65 or older felt socially isolated and over 1 million (1,018,000) (24%) reported low participation. In multivariate Cox models, low participation was significantly associated with death for men and women even when the potential confounding effects of subjective isolation, socio-demographic characteristics, health status, and health behaviours were considered. Subjective isolation was not associated with death in final multivariate models for men or women. SEM revealed significant associations between low participation and survival time for men and women. In addition to the direct effects, there were significant indirect effects mediated by health status. There were no direct effects of subjective isolation on survival for men or women, only indirect effects mediated through health status.
Interpretation
Subjective and objective isolation differed in their association with mortality.
Keywords
loneliness, morbidity, data linkage, path analysis, structural equation modelling, aging
DOI: https://www.doi.org/10.25318/82-003-x202000300003-eng
Findings
The impact of social isolation and loneliness on health and well-being is recognized globally as a public health issue. The United Kingdom appointed a Ministerial lead on loneliness and the World Health Organization recognizes the impact of social isolation on disability and death. Research generally demonstrates that social isolation is associated with increased risk of mortality on par with or greater than more traditional risk factors such as alcohol use, smoking and obesity. [Full article]
Authors
Heather Gilmour (Heather.Gilmour@canada.ca) and Pamela L. Ramage-Morin are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.
What is already known on this subject?
- There is no gold standard for the definition and measurement of social isolation.
- Some definitions focus on objectively measured characteristics such as the number of social contacts or frequency of social participation.
- Others are based on subjective feelings such as loneliness or perceptions of being excluded.
- Both subjective and objective assessments of social isolation have been associated with increased risk of death
What does this study add?
- Men and women aged 65 or older were equally likely to be low participators – an objective measure of social isolation.
- Women were more likely than men to report feelings of social isolation.
- Low participation was associated with risk of death (shorter survival time) for both men and women.
- Subjective social isolation was not directly associated with death; there was an indirect effect mediated through health status.
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