Abstract
Hypertension has reached epidemic levels in rural China, where loneliness has been a major problem among community dwellers as a consequence of rural-to-urban migration among younger generations. The objective of the study is to investigate the association between loneliness and hypertension, and whether social support can buffer the association (i.e., stress buffering theory), using cross-sectional data from 765 adults (mean age: 59.1 years) in rural Fujian, China. Social support was measured as the reciprocal instrumental social support from/to neighbors and the reciprocal emotional support (i.e., the number of close friends that the respondent could turn to for help immediately when they are in trouble). A mixed-effect Poisson regression model with a robust variance estimator was used to investigate the association between loneliness, social support, and hypertension. Analysis revealed that those who were lonely had a higher prevalence ratio for hypertension (prevalence ratio = 1.12, 95% confidence interval 0.99-1.26) compared to those who reported not being lonely. There was an interaction between social support and loneliness in relation to hypertension. Specifically, contrary to the stress buffering theory, the positive association between loneliness and hypertension was more pronounced among those who reported higher social support compared to those who reported lower support (p for interaction <0.001 for instrumental support). The results suggest that being lonely despite high levels of social support poses the greatest risk for hypertension. This study did not confirm a buffering effect of social support on the association between loneliness and hypertension.
Highlights
Social support was measured as the reciprocal instrumental social support from/to neighbors and the reciprocal emotional support
There was an interaction between social support and loneliness in relation to hypertension
The results suggest that being lonely despite high levels of social support poses the greatest risk for hypertension
Summary
More than 1.13 billion people are affected with hypertension globally [1]. Among risk factors for hypertension (e.g., salt in the diet, overweight/obesity, tobacco use, and physical inactivity) [2], recent studies have suggested that loneliness, which has been defined as the subjective feeling that accompanies the perception that one’s social needs are not being met by the quantity or quality of one’s social relationships [3], may be an important risk factor for hypertension [4–6]. Meta-analyses have shown that loneliness is a risk factor for coronary heart disease, stroke [7] and all-cause mortality [8]. In China, loneliness has been singled out as a major problem among rural community dwellers [9]. The prevalence of loneliness among older people in rural areas ranges from 25% to 78% [9, 11]. These sociodemographic transitions might have underlain the increase in disease burden associated with hypertension; mortality attributable to hypertension in China almost doubled during the decade from 2007 to 2017 [12], with a larger increase observed in rural vs urban areas [13, 14]. To date, there have been no studies that examined the association between loneliness and hypertension in China
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