TY - JOUR
T1 - Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease
T2 - A Systematic Review, Meta-Analysis, and Meta-Regression
AU - Long, Róisín M.
AU - Terracciano, Antonio
AU - Sutin, Angelina R.
AU - Creaven, Ann Marie
AU - Gerstorf, Denis
AU - D'Arcy-Bewick, Sinéad
AU - O'Súilleabháin, Páraic S.
N1 - Publisher Copyright:
Copyright © 2022 by the American Psychosomatic Society.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Objective: This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. Methods: Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. Results: Living alone was associated with increased risk of all-cause mortality (k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable (k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable (k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. Conclusions: Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.
AB - Objective: This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. Methods: Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. Results: Living alone was associated with increased risk of all-cause mortality (k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable (k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable (k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. Conclusions: Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.
KW - cardiovascular disease
KW - living alone
KW - loneliness
KW - mortality
KW - social isolation
UR - http://www.scopus.com/inward/record.url?scp=85144437098&partnerID=8YFLogxK
U2 - 10.1097/PSY.0000000000001151
DO - 10.1097/PSY.0000000000001151
M3 - Article
C2 - 36441849
AN - SCOPUS:85144437098
SN - 0033-3174
VL - 85
SP - 8
EP - 17
JO - Psychosomatic Medicine
JF - Psychosomatic Medicine
IS - 1
ER -