Evaluation of Social Isolation Trajectories and Incident Cardiovascular Disease Among Middle-Aged and Older Adults in China: National Cohort Study

Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. This stud...

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Bibliographic Details
Published in:JMIR public health and surveillance 2023-06, Vol.9, p.e45677
Main Authors: Guo, Lan, Wang, Wanxin, Shi, Jingman, Zheng, Xinyu, Hua, Yilin, Lu, Ciyong
Format: Article
Language:English
Subjects:
Aged
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - epidemiology
China - epidemiology
Cohort Studies
Female
Health hazards
Heart Diseases
Humans
Hypertension
Longitudinal Studies
Male
Middle Aged
Older people
Original Paper
Socioeconomic factors
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Summary:Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension
ISSN:2369-2960
2369-2960
DOI:10.2196/45677