medwireNews: A cohort study published in JAMA Internal Medicine has identified a significant association between social isolation and increased mortality in adults with chronic obstructive pulmonary disease (COPD).
Angela Suen, from the University of California in San Francisco, USA, and colleagues, analyzed the impact of social isolation on all-cause mortality using data from the Health and Retirement Survey (2006–2022), a biennial longitudinal study of US adults aged 51 years or older. Their analysis included 1241 individuals with self-reported COPD (mean age 68.4 years; 59.3% women).
Social isolation was assessed using a validated social isolation scale, where participants scored 1 point each for factors that included being unmarried, living alone, having no social contact with family or friends, and no community participation. A total score of 3 points or more out of a possible 6 points was used to define social isolation.
The study included community-dwelling participants who responded to at least three of the social isolation questions. All-cause mortality was determined using date-of-death records, with adjustments made for age, sex, race, ethnicity, comorbidities, and other factors linked to social isolation and loneliness.
Over a median follow-up of 4.4 years, the rate of death was 43.4%. The 23.6% of COPD patients who reported experiencing social isolation had a higher risk for mortality than those who did not, at a significant hazard ratio of 1.35.
Socially isolated patients with COPD had a significantly shorter median survival time than those with more active social lives (7.0 vs 9.1 years), and a significantly lower rate of survival, with 62.9% still alive at 5 years, compared with 71.1% of their non-isolated counterparts.
The analysis also showed that socially isolated COPD patients were significantly more likely than their non-socially isolated peers to require supplemental oxygen (19.6 vs 12.3%), experience high depressive symptoms (31.9 vs 23.8%), and have cognitive impairment – both non-dementia cognitive impairment (19.0 vs 15.4%) and dementia (5.9 vs 2.9%).
While the authors acknowledge the study’s limitations, including the reliance on self-reported COPD diagnoses, which may include other chronic lung conditions, they hypothesize that socially isolated patients face limited “access to necessary support and resources for managing debilitating symptoms such as breathlessness, functional limitations and complex medical regimens, particularly after hospital or intensive unit stays.” This lack of support, could, in part, explain the 35% increase in mortality risk, they write.
Suen et al say: “[O]ur findings suggest that expanding interdisciplinary efforts to reduce or prevent social isolation among patients with COPD may complement current disease-directed treatment strategies.”
They conclude that “[f]uture studies should investigate strategies to reduce social isolation among patients with COPD and whether these efforts may improve health outcomes.”
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