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Cited by 2,503Health disparities and outcomesAging, Health, and DisabilityDeath Anxiety and Social Exclusion

Social isolation, loneliness, and all-cause mortality in older men and women

Open access
Steptoe, Andrew, Shankar, Aparna, Demakakos, Panayotes, Wardle, Jane·2013·Proceedings of the National Academy of Sciences
DOI 10.1073/pnas.1219686110PMC PMC3625264
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Abstract

Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004–2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08–1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78–1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.

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Registry

Crossref · 10.1073/pnas.1219686110

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Further adjustment for baseline health and depression reduced the social isolation-mortality association by 12%.

    “Adjustment for demographic factors including marital status reduced the strength of this association by around 36% (model 2), with a further reduction of 12% when baseline health status and depression were taken into account (model 3).”
    Quote in the paperNot a substantial claim
  • Findingown data

    After adjustment for age and sex, high social isolation was associated with mortality HR 1.50 (95% CI 1.30-1.73, P < 0.001).

    “Cox proportional hazard analyses showed that, after adjustment for age and sex, the hazards ratio (HR) for mortality was 1.50 [95% confidence interval (CI), 1.30-1.73,P < 0.001] in the high social isolation group (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    After adjustment for demographic factors and baseline health, loneliness was not significantly associated with all-cause mortality (HR 0.92, 95% CI 0.78-1.09).

    “However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08-1.48for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09).”
    • Also stated in: § Results · hedged
      “The association was attenuated further after baseline health and mobility were included in the model (HR 0.92, 95% CI, 0.78-1.09,P = 0.34), suggesting that social disadvantage and concurrent health problems largely account for the relationship between loneliness and mortality.”
    Quote in the paperSubstantial claim
  • Findingown data

    After adjustment for age and sex, loneliness was associated with mortality HR 1.26 (95% CI 1.08-1.46, P = 0.003).

    “The age-and sex-adjusted HR for loneliness was significant (1.26, 95% CI, 1.08-1.46,P = 0.003) but was reduced to nonsignificance when demographic factors were included (model 2, Table 3).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In ELSA, greater loneliness was associated with higher all-cause mortality.

    “Both social isolation and loneliness were associated with all-cause mortality; the absolute proportions of deaths were 21.9 vs. 12.3% in the high and low/ average isolation groups and 19.2 vs. 13.0% in the high and low/ average loneliness groups, respectively.”
    • Also stated in: § Results · hedged
      “The age-and sex-adjusted HR for loneliness was significant (1.26, 95% CI, 1.08-1.46,P = 0.003) but was reduced to nonsignificance when demographic factors were included (model 2, Table 3).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 8
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Isolated individuals were more likely to be older, unmarried, less educated, and less wealthy.

    “There were no sex differences in social isolation, but isolated individuals were more likely to be older and unmarried with limited education and lower wealth.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Loneliness was associated with older age, less education, lower wealth, and marital status.

    “Loneliness was more common in women and was associated with older age, less education, and lower wealth and marital status in the same way as social isolation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Loneliness was associated with a wider range of health conditions than social isolation, including CHD, stroke, and clinical depression, although these conditions were uncommon.

    “It was associated with a greater range of health conditions than social isolation, including coronary heart disease (CHD), stroke, and clinical depression, although the prevalence of these conditions was low.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Social isolation and loneliness were positively correlated (ρ = 0.10, P < 0.001).

    “Social isolation and loneliness were positively correlated (ρ = 0.10, P < 0.001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Social isolation was associated with limiting longstanding illnesses, chronic lung disease, arthritis, impaired mobility, and depressive symptoms.

    “Social isolation also was associated with limiting longstanding illnesses such as chronic lung disease, arthritis, impaired mobility, and depressive symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the Health and Retirement Study, loneliness predicted all-cause mortality over six years independently of demographic factors and health behaviors, but the association became nonsignificant after baseline health, functional limitations, and depressive symptoms were controlled.

    “In the HRS, loneliness predicted all-cause mortality over a 6-y period independently of demographic factors and health behaviors, but associations no longer were significant after baseline health, functional limitations, and depressive symptoms were taken into account (26).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Depression is a risk factor for death from common serious illnesses.

    “Because depression is a risk factor for mortality from common serious illness (37)(38)(39) and also is associated with social isolation and loneliness, it was included as an additional covariate.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (37)(38)(39)

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All-cause mortality data up to March 2012 were supplied by the NHS central data registry for 96.5% of participants who consented to follow-up.

    “All-cause mortality up to March 2012 was supplied by the National Health Service central data registry for all participants who consented to mortality follow-up (96.5%).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Loneliness was measured with the three-item short form of the Revised UCLA loneliness scale.

    “We measured loneliness with the three-item short form of the Revised UCLA loneliness scale (29).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The loneliness item was omitted from the CES-D to avoid overlap, and results were similar when it was included.

    “The item on loneliness was omitted from the CES-D to avoid direct overlap with the loneliness scale (41); however, the same results emerged when this item was included.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The mortality risk of social isolation is partly caused by social disadvantage or poor health, but much of the association remains unexplained.

    “This result indicates that the mortality risk of social isolation is caused partly by social disadvantage or poor health, but much of the association remains unexplained.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Equal weight was given to different aspects of social contact in the analyses.

    “We gave equal weight to different aspects of social contact in these analyses, but some social relationships may be more important to future health than others.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The social isolation index was comprehensive, including contacts with friends, relatives, family, and civic participation.

    “We also were able to construct a comprehensive social isolation index that included contacts with friends, relatives, and family as well as civic participation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ethical approval for ELSA was given by the National Research Ethics Service.

    “Ethical approval for ELSA was given by the National Research Ethics Service.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The analysis used a large representative population cohort and controlled for multiple health and demographic indicators.

    “The strengths of this analysis include the use of a large representative population cohort in which it was possible to control for multiple health and demographic indicators.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The response rate in wave 2 was 81.5% of eligible participants.

    “The response rate in wave 2 was 81.5% of eligible participants.”
    Quote in the paperNot a substantial claim
16 of 16

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Cites

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Research works printed but not linked: 2

  1. LA Peplau, D Perlman, Perspectives on loneliness. Loneliness: A Sourcebook of Current Theory, Research and Practice, eds LA Peplau, D Perlman (John Wiley, New York), pp. 1–17 (1982).
  2. J Banks, S Karlsen, Z Oldfield, Socio-economic position. Health, Wealth and Lifestyles of the Older Population in England, eds M Marmot, J Banks, R Blundell, C Lessof, J Nazroo (Institute for Fiscal Studies, London), pp. 71–125 (2003).

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Related

Authors
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J.
Affiliations
University College London (GB)
ORCID
Venue
Proceedings of the National Academy of Sciences
Publisher
National Academy of Sciences
Published
2013-03-25
Volume
110
Issue
15
Pages
5797-5801
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
DOI
10.1073/pnas.1219686110
PMC
PMC3625264
OpenAlex
W2004761428
Cited by
2,503
References
41
Citations by year
2026: 188 · 2025: 248 · 2024: 286 · 2023: 247 · 2022: 273 · 2021: 285 · 2020: 265 · 2019: 175 · 2018: 145 · 2017: 129 · 2016: 98 · 2015: 85 · 2014: 58 · 2013: 18
FWCI
98.25
Type
journal article
Language
en
Open access
Locations
  • Proceedings of the National Academy of Sciences (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Government of the United Kingdom
  • Cancer Research UK (14134)
  • British Heart Foundation
  • University College London
  • Economic and Social Research Council (ES/K003178/1)
  • National Institute on Aging (2R01AG7644, 2R01AG7644-01A1, R01AG017644)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
  • Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
Keywords
social isolation, loneliness, all-cause mortality, older adults, mediation, family and friend contact, citizen participation, English Longitudinal Study of Ageing
MeSH terms
Aged, Aging, Emotions, Female, Health Status, Humans, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, Quality of Life, Surveys and Questionnaires, Regression Analysis, Risk Factors, Social Behavior, Social Isolation, Proportional Hazards Models

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