1. Social isolation was found highly correlated to traditional clinical risk factors and found more predictive of mortality than high blood pressure.
2. Infrequent religious activity was found to be the social isolation factor most predictive of mortality.
Evidence Rating Level: 2 (Good)
Study Rundown: Previous independent and small-scale studies have identified associations between social isolation and clinical risk factors including mortality. This national study (n=16,849) sought to identify the risk of social isolation when correlated and compared to traditional clinical risk factors. Researchers used the Berkman-Syme Social Network Index (SNI) composed of questions related to relationships and community activity participation to indicate social isolation and analyzed data from the Third National Health and Nutrition Survey (NHANES III) to identify findings.
Analysis found that when compared to more socially engaged populations, individuals with a high degree of social isolation had significantly higher rates of high blood pressure in women and tobacco use in both men and women. Furthermore, when a sensitivity analysis was performed to minimize covariation, social isolation predicted mortality at a hazard ratio similar to smoking in both men and women. This study is the first large scale study to show the significant comparative impact of social isolation on clinical risk factors, however it is difficult to identify independent associations in a data set like this with so many different variables. For instance, while there was correlation between social isolation and clinical risk factors, there was also a significant correlation between social isolation and poverty which is also highly correlated with the negative risk factors. Future research on this topic will certainly involve looking at the impact of new social media technologies as interventions as well as continued investigation of biological explanations for these observations (see relevant reading below).
Relevant Reading: Social regulation of gene expression in human leukocytes
In-Depth [prospective study]: This was the first study to look at social isolation stratified by gender as well as using a combined social isolation measure and comparing the value of social isolation to other clinical risk factors (blood pressure, smoking, obesity, and cholesterol level). As noted above, researchers found that tobacco use was 33.4% among women with a high degree of social isolation compared to 13.8% among more socially engaged women (p<.001), results were similar in men 43.6% among socially isolated individuals and 15.2% within their more socially engaged counterparts (p<.001).
When Cox models were used to evaluate how social isolation predicted mortality compared with other clinical risk factors: social isolation in men had a hazard ratio (HR=1.62; 95% CI: 1.29, 2.02) greater than that of high blood pressure (HR=1.16; 95% CI=1.02,1.32). Furthermore, results were more significant in the female cohort as social isolation was predictive of mortality (HR=1.75; 95% CI: 1.38, 2.23) at a higher degree than elevated blood pressure (HR=1.32; 95% CI: 1.17, 1.48). Researchers also found that infrequent religious activity, as an independent variable, was most predictive of mortality among men (HR=1.27; 95% CI: 1.13, 1.42) and women (HR=1.35; 95% CI: 1.17, 1.56).
By Jordan Anderson and Andrew Bishara
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