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UK Biobank study links social connections with reduced all-cause and cardiovascular mortality

In a recent study published in BMC Medicine, researchers examined the associations between functional and structural components of social connection and all-cause and heart problems (CVD) mortality using data from the UK (UK) Biobank.



They examined independent and combined associations to grasp how these social components interacted.

Study: Social connection and mortality in UK Biobank: a prospective cohort evaluation. Image Credit: antoniodiaz/Shutterstock.com

Background

Between 9.2 and 14.4% of the worldwide population feels lonely, and 25% of adults is perhaps socially isolated; these statistics indicating the extent of an absence of social connection raise concern.

There are interrelated structural (e.g., frequency of social visits with family and friends) and functional (e.g., perceived loneliness) components of social connection, and the deficit of even one could heighten the chance of all-cause and CVD mortality. 

Prior studies have shown independent associations between a functional or structural social connection component and a better risk of all-cause mortality using a single-item measure. 

Then again, some studies used composite scales, e.g., the Berkman-Syme Social Network Index, to measure the structural component of social connection.

A meta-analysis of prospective studies examined the association between functional or structural social connection and all-cause mortality and even quantified them.

Nonetheless, the observed effect sizes represented the mixture effects of various measures, showing no accountability towards the strength of every measure and its impact on health. These analyses, nonetheless, failed to acknowledge potential synergistic interactions between functional and structural components.

Several mechanisms come into play when examining this association; for example, reverse causality, where disabilities hinder people from forming or sustaining relationships. Nonetheless, which social connection components are related to mortality stays unclear, whether or not they vary with the assessment methods or how direct and indirect aspects influence them. 

Poor immune function and neurodevelopmental impairment are a number of the aspects directly influencing this association, while substance abuse and poor mental or physical health not directly affect this association.

Overall, there may be an absence of research examining different components of social connection in a single dataset to delineate all their effects, including independent, additive, and multiplicative effects. 

Insights into the health impact of various social connection components and their interactions could help guide policy to reinforce social connectedness and improve health via targeted interventions.

Concerning the study

In the current study, researchers invited 502,536 UK Biobank participants enrolled between 2006 and 2010 to go to considered one of the 22 assessment centers in England, Scotland, or Wales.

They collected their baseline data, which included their physical measurements and extra information collected using a questionnaire and an interview taken by a trained healthcare skilled.

The team examined baseline data and all-cause and CVD mortality (antagonistic health outcomes), where the International Classification of Diseases (ICD) tenth revision codes I05 to I99, G45, G46, and Z86.7 defined CVD mortality.

Further, they measured their ability to confide in someone close and feelings of loneliness (two functional components) and the frequency of family and friends visits, weekly group activity, and living alone (three structural components).

Study covariates included self-reported sex, ethnicity, smoking status, alcohol intake, physical activity levels, the month of assessment, and 43 long-term health conditions. Besides, they included body mass index (BMI) as a continuous measure and postcode of residence at recruitment as a continuing variable.

The researchers used a Cox proportional hazard model (time-to-event evaluation) to look at the associations between social connection and mortality for all participants.

Given highly connected measures of social connection and the covariates, they detected potential multicollinearity using generalized variance inflation aspects (GVIF) for all study variables.

They then examined the association between each functional component measure and antagonistic health outcomes individually, adjusting for all confounders.

In addition they investigated the combined association of those measures and their interactions concerning antagonistic health outcomes. In addition they created a brand new dichotomous ‘functional isolation’ variable and examined its associations with mortality.

Structural component analyses examined the association between each structural component measure and antagonistic health outcomes individually. Finally, the researchers also investigated the combined effect of functional and structural components.

Results

The principal evaluation encompassed 458,146 UK Biobank participants with a mean age of 56.5 years. Of those, 95.5% were of white ethnicity, and 54.7% were women. Of a complete of 33,135 deaths in the course of the average follow-up of 12.6 years, 1.1% were as a result of CVDs.

Usually, participants reporting reduced social connection were more likely involved in unhealthy practices (e.g., smoking), were deprived socioeconomically, and belonged to a minority ethnicity. In addition they had higher BMI and more long-term health conditions.

Participants reporting functional measures of social connection, inability to confide in others, and feeling lonely showed a powerful association with higher all-cause and CVD mortality, with respective hazard ratios (HRs) of 1.07 and 1.17 and 1.06 and 1.08, respectively.

Combining these measures formed a brand new dichotomous functional isolation variable, which also showed an association with higher all-cause and CVD mortality, with HRs of 1.08 and 1.16, respectively.

Fully adjusted models of associations between the frequency of family and friends visits and all-cause mortality showed that visits to family and friends lower than once a month were related to a much higher risk of all-cause mortality, with HRs for once every three months and never of 1.11 and 1.39, respectively.

The pattern was similar for CVD mortality, but associations were stronger and had wider confidence intervals (CIs).

Once-a-month visits to shut ones provided maximum advantages, and once validated in other datasets, it could help discover which measures of social connection could be most useful to focus on via interventions.

Likewise, not engaging in weekly group activity and living alone increased the chance of all-cause and CVD mortality, HRs: 1.13 and 1.10 and 1.25 and 1.48, respectively, in comparison with those that engaged in group activities weekly and lived with at the very least one other.

Models of combined associations also showed that fewer family and friends visits heightened the chance of all-cause mortality no matter whether participants reported engaging in a weekly group activity.

Moreover, examining the combined associations between the 2 functional component measures and all-cause mortality when structural isolation was present showed that being unable to confide was related to higher all-cause mortality no matter feelings of loneliness (HRs: 1.41 vs. 1.38). 

Nonetheless, within the absence of structural isolation, this association showed a greater difference between that reporting often feeling lonely and never (HR 1.16 vs. 1.07), highlighting the complexity and possible hierarchy in social connection components, especially for individuals who experienced quite a few varieties of social disconnection.

Thus, it’s critical to think about different measures when exploring the combined effects of all social components on health outcomes.

As an illustration, the authors observed that an absence of family and friends visits and living alone masked the lower risk of mortality related to regular group activity.

Exploring this idea in other datasets could highlight intervention targets for essentially the most isolated people in society.

Conclusions

To date, there isn’t any standardized measure for social connection. Nonetheless, the independent associations observed on this study between risks of living alone and mortality and its interactions with family and friends visits and weekly group activity point to further work ascertaining whether living alone could represent a simplified measure in studies examining social connection.

Those that live alone and show additional concurrent markers of structural isolation represent a population that may benefit from targeted support. Thus, policies and interventions that address different social connection components should goal such high-risk groups.

Future studies should investigate the role of potential mediators (e.g., mental health problems) to elucidate the mechanistic pathways by which social disconnection causes mortality.

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