Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Freak-Poli, Rosanne; Ryan, Joanne; Neumann, Johannes T.; Tonkin, Andrew; Reid, Christopher M.; Woods, Robyn L.; Nelson, Mark; Stocks, Nigel; Berk, Michael; McNeil, John J.; Britt, Carlene; Owen, Alice J.

doi:10.1186/s12877-021-02602-2

BMC Geriatrics

Table 2 Social health as a predictor of incident and fatal cardiovascular disease^a over 5 years for older adults recruited between 2010 and 2014 in Australia, n = 11,486

From: Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

End point	Social isolation								Social support
	Not (n = 11,262)		Isolated (n= 224)		Hazard Ratio^h	p–value	95 % Confidence Interval		High (n = 11,258)		Low (n = 228)		Hazard Ratio^h	p–value	95 % Confidence Interval
	events	rate	events	rate	Hazard Ratio^h	p–value	95 % Confidence Interval		events	rate	events	rate	Hazard Ratio^h	p–value	95 % Confidence Interval
Cardiovascular disease^b	470	41.7	17	75.9	1.66	0.04	1.02	2.70	467	41.5	20	87.7	2.05	0.002	1.31	3.21
Fatal cardiovascular disease^c	82	7.3	1	4.5	n < 5				81	7.2	2	8.8	n < 5
Major adverse cardiovascular event^d	360	32.0	10	44.6	1.21	0.6	0.64	2.27	356	31.6	14	61.4	1.79	0.03	1.05	3.07
Hozpitalization for heart failure^e	94	8.3	5	22.3	2.58	0.04	1.04	6.39	96	8.5	3	13.2	n < 5
Fatal or nonfatal myocardial infarction^f	201	17.8	6	26.8	1.24	0.6	0.55	2.81	202	17.9	5	21.9	1.09	0.9	0.45	2.65
Fatal or nonfatal ischemic stroke^g	189	16.8	9	40.2	2.34	0.01	1.19	4.59	186	16.5	12	52.6	3.16	<0.001	1.76	5.68
End point	Loneliness								Social Health compositeⁱ
	Not (n = 10,927)		Lonely (n = 559)		Hazard Ratio^h	p–value	95 % Confidence Interval		Poor (n = 910)		Positive (n = 10,576)		Hazard Ratio^h	p–value	95 % Confidence Interval
	events	rate	events	rate	Hazard Ratio^h	p–value	95 % Confidence Interval		events	rate	events	rate	Hazard Ratio^h	p–value	95 % Confidence Interval
Cardiovascular disease^b	454	41.5	33	59.0	1.4	0.10	0.95	1.93	56	61.5	431	40.8	1.42	0.01	1.07	1.88
Fatal cardiovascular disease^c	72	6.6	11	19.7	2.55	0.004	1.34	4.83	14	15.4	69	6.5	2.00	0.02	1.12	3.60
Major adverse cardiovascular event^d	343	31.4	27	48.3	1.50	0.045	1.01	2.22	41	45.1	329	31.1	1.35	0.07	0.97	1.87
Hozpitalization for heart failure^e	94	8.6	5	8.9	0.87	0.8	0.35	2.15	87	8.2	12	13.2	1.41	0.3	0.77	2.59
Fatal or nonfatal myocardial infarction^f	194	17.8	13	23.3	1.34	0.3	0.76	2.36	186	17.6	21	23.1	1.24	0.4	0.79	1.95
Fatal or nonfatal ischemic stroke^g	181	16.6	17	30.4	1.73	0.03	1.05	2.86	171	16.2	27	29.7	1.76	0.007	1.17	2.65

^a As some end points were composites, a participant who had events for more than one component of the composite (e.g., stroke and then acute myocardial infarction) would contribute only the first event that occurred to the composite end point but would contribute an event to the separate analyses of each component. Hence, summation of the number of events for separate components of a composite end point does not equate to the number of events for the composite end point. If there are fewer than five participants in a cell, then statistics are not reported to preserve participant’s privacy and potential unreliable statistical inferences
^b CVD incidence, a prespecified secondary end point, was a composite of fatal CHD (death from myocardial infarction, sudden cardiac death, or any other death in which the underlying cause was considered to be CHD), nonfatal myocardial infarction, fatal or nonfatal stroke (including haemorrhagic stroke), or hospitalization for heart failure. 50,887 person-years of observation (mean 4.43 ± 1.28SD years; median 4.51, IQR 3.48-5.53, range 0–7)
^c Fatal CVD was defined as any death from stroke (including haemorrhagic stroke) or CHD. 52,353 person-years of observation (mean 4.55 ± 1.21SD years, median 4.61, IQR 3.58-5.60, range 0–7). Fatal CVD assessed for competing events (cancer death, major haemorrhage death, other death)
^d Major adverse cardiovascular events, a non-prespecified end point, was a composite of fatal CHD (excluding death from heart failure), nonfatal myocardial infarction, or fatal or nonfatal ischemic stroke. 51,063 person-years of observation (mean 4.44 ± 1.26SD years, median 4.52, IQR 3.48-5.54, range 0–7)
^e 51,497 person-years of observation (mean 4.48 ± 1.24SD years, median 4.54, IQR 3.51-5.56, range 0–7)
^f 51,297 person-years of observation (mean 4.47 ± 1.25SD years, median 4.54, IQR 3.50-5.55, range 0–7)
^g Data for ischemic stroke included cases that were adjudicated as ischemic stroke, cases for which stroke type was uncertain after adjudication, and cases of ischemic stroke with haemorrhagic transformation. 51,349 person-years of observation (mean 4.47 ± 1.25SD years, median 4.54, IQR 3.50-5.55, range 0–7)
^h Adjusted based on a primary CVD risk assessment tool developed specifically from this cohort 28: age (years), gender (women, men), smoking (never, past, current), systolic blood pressure (mmhg), high-density lipoprotein (HDL-c; mmol/L), non-HDL (mmol/L), diabetes (yes, no), serum creatinine (mg/dL), and antihypertensive drug use (yes, no)
ⁱ The social health composite categories were defined as positive (not isolated, supported, and not lonely), or poor (isolated, not supported and/or lonely)

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