Abstract
Social relationships are associated with all-cause mortality. Substantial uncertainties remain, however, for the associations of social relationships with mortality from subtypes of cardiovascular disease (CVD) and major non-vascular diseases. This prospective cohort study estimated mortality risks according to social support and social integration utilizing a nationally representative sample of 29,179 adults ages 18 years and older. Cox proportional hazards regression models were employed. Social integration, but not social support was associated with all-cause mortality risk. For CVD mortality, social integration predicted a 33% lower risk (HR = 0.67, 95% CI = 0.53–0.86). The results were similar in magnitude for heart disease mortality. Participants with the highest social integration level had a 53%, 30%, and 47% decreased mortality risk of diabetes, Alzheimer’s disease, and chronic lower respiratory diseases (CLRD) than those with the lowest level. These social integration associations were linear and consistent across baseline age, sex and socioeconomic status. We did not observe an association of social integration with the risk of cancer mortality. Our findings support the linear association of social integration but not social support with mortality from a range of major chronic diseases in the US adult population, independent of socioeconomic status (SES), behavioral risk factors, and health status.
Highlights
People with greater social connectedness and stronger ratings of social support tend to live longer [1]
During 0.4 million person-years of follow-up, a total of 5071 deaths were recorded, including 1231 from cancer, 1141 from cardiovascular disease (CVD) (889 and 252 deaths attributed to heart disease and stroke, respectively), 255 from chronic lower respiratory diseases (CLRD), 175 from diabetes, and 128 from Alzheimer’s disease
We found that the association was stronger with the risk of diabetes mortality than that of other chronic disease mortality, which could be partly explained by the stronger relationship between behavioral risk factors and the incidence risk of diabetes [20]
Summary
People with greater social connectedness and stronger ratings of social support tend to live longer [1]. In 1988, House and colleagues demonstrated a causal relationship between social relations and the risk of mortality [2]. 148 studies showed that both functional and structural relationships were inversely associated with a 50% reduction in mortality rates, which was comparable to common health risk factors such as smoking and diabetes [3]. Social relationships have been hypothesized to improve health through various mechanisms, such as stress buffering, role modeling and social control of health behaviors [6]. Those with poor social relationships have less healthy behaviors, lower levels of immunity and increased inflammation which may lead to bad health outcomes [7]. Public Health 2019, 16, 1498; doi:10.3390/ijerph16091498 www.mdpi.com/journal/ijerph
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