Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women
Open accessAbstract
Objective: To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions. Methods: Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes. Results: Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model. Conclusions: Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In over 450,000 UK Biobank participants, neither isolation nor loneliness predicted a first heart attack, but isolation did predict death among those with prior cardiovascular disease or stroke.
“For example, an analysis of more than 450,000 participants in the UK Biobank tested associations between social isolation, loneliness, and acute myocardial infarction (MI). Neither factor was associated with first MI, but social isolation predicted mortality among people with a history of cardiovascular disease or stroke [29].”
From Social isolation: an underappreciated determinant of physical health (2022) · cites this paper as [29]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Sudlow, C., Gallacher, J., Allen, N., Beral, V., Burton, P., Danesh, J., Downey, P., Elliott, P., Green, J., Landray, M., et al. (2015) · PLOS Medicine · doi:10.1371/journal.pmed.1001779 · Cited by 12,728 · see citing works
Spitzer, R. L. (1999) · JAMA · doi:10.1001/jama.282.18.1737 · Cited by 9,802 · see citing works
Multiple imputation using chained equations: Issues and guidance for practice
White, I. R., Royston, P., & Wood, A. M. (2011) · Statistics in Medicine · doi:10.1002/sim.4067 · Cited by 9,792 · see citing works
Social Relationships and Mortality Risk: A Meta-analytic Review
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000316 · Cited by 7,272 · cited 1× · see citing works
“The results from the complete case analyses were similar to those previously reported (online supplementary efigures 4–5).”
ResultLoneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015) · Perspectives on Psychological Science · doi:10.1177/1745691614568352 · Cited by 6,043 · see citing works
BERKMAN, L. F., & SYME, S. L. (1979) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112674 · Cited by 5,341 · see citing works
The Emerging Risk Factors Collaboration (2010) · The Lancet · doi:10.1016/s0140-6736(10)60484-9 · Cited by 5,125 · see citing works
A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004) · Research on Aging · doi:10.1177/0164027504268574 · Cited by 4,781 · see citing works
Mechanisms Linking Social Ties and Support to Physical and Mental Health
Thoits, P. A. (2011) · Journal of Health and Social Behavior · doi:10.1177/0022146510395592 · Cited by 4,076 · see citing works
Social isolation, loneliness, and all-cause mortality in older men and women
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1219686110 · Cited by 2,503 · see citing works
Executive Summary: Heart Disease and Stroke Statistics—2016 Update
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., de Ferranti, S. D., Després, J., Fullerton, H. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000366 · Cited by 2,503 · see citing works
Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006) · Psychology and Aging · doi:10.1037/0882-7974.21.1.140 · Cited by 2,380 · see citing works
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016) · Heart · doi:10.1136/heartjnl-2015-308790 · Cited by 1,971 · see citing works
Health and Deprivation: Inequality and the North
Townsend, P. D., Phillimore, P., & Beattie, A. (1987) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 1,385 · see citing works
Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000019 · Cited by 1,208 · see citing works
What makes UK Biobank special?
Collins, R. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60404-8 · Cited by 1,128 · see citing works
The neuroendocrinology of social isolation
Cacioppo, J. T., Cacioppo, S., Capitanio, J. P., & Cole, S. W. (2015) · Annual Review of Psychology · doi:10.1146/annurev-psych-010814-015240 · Cited by 977 · see citing works
Stress and Cardiovascular Disease: An Update on Current Knowledge
Steptoe, A., & Kivimäki, M. (2013) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031912-114452 · Cited by 879 · see citing works
Choice of time‐scale in Cox's model analysis of epidemiologic cohort data: a simulation study
Thiébaut, A. C. M., & Bénichou, J. (2004) · Statistics in Medicine · doi:10.1002/sim.2098 · Cited by 633 · see citing works
ESTIMATING THE PROPORTION OF TREATMENT EFFECT EXPLAINED BY A SURROGATE MARKER
Lin, D. Y., Fleming, T. R., & Gruttola, V. D. (1997) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19970715)16:13 · Cited by 520 · see citing works
Eng, P. M., Rimm, E. B., Fitzmaurice, G., & Kawachi, I. (2002) · American Journal of Epidemiology · doi:10.1093/aje/155.8.700 · Cited by 492 · see citing works
Elovainio, M., Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Josefsson, K., Jokela, M., Vahtera, J., & Kivimäki, M. (2017) · The Lancet Public Health · doi:10.1016/s2468-2667(17)30075-0 · Cited by 411 · see citing works
Self-citationSocioeconomic Status and Health: Mediating and Moderating Factors
Chen, E., & Miller, G. E. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185634 · Cited by 402 · see citing works
Palmer, L. J. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60924-6 · Cited by 377 · see citing works
Social isolation and outcomes post stroke
Boden-Albala, B. M., Litwak, E., Elkind, M. S. V., Rundek, T., & Sacco, R. L. (2005) · Neurology · doi:10.1212/01.wnl.0000163510.79351.af · Cited by 320 · see citing works
Holt‐Lunstad, J., & Smith, T. B. (2016) · Heart · doi:10.1136/heartjnl-2015-309242 · Cited by 260 · see citing works
Mons, U., Hahmann, H., & Brenner, H. (2014) · Heart · doi:10.1136/heartjnl-2013-305242 · Cited by 171 · see citing works
Hakulinen, C. A., Pulkki-Råbäck, L., Jokela, M. M., Ferrie, J. E., Aalto, A., Virtanen, M., Mika Kivimaki, B., Vahtera, J., & Elovainio, M. J. (2016) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2015-206165 · Cited by 129 · see citing works
Self-citationSocial Network, Social Support, and Risk of Incident Stroke
Nagayoshi, M., Everson‐Rose, S. A., Iso, H., Mosley, T. H., Rose, K. M., & Lutsey, P. L. (2014) · Stroke · doi:10.1161/strokeaha.114.005815 · Cited by 94 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175 · see citing works
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300 · see citing works
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987 · see citing works
Donovan, N. J., & Blazer, D. (2020) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.08.005 · Cited by 739 · see citing works
Lim, M. H., Eres, R., & Vasan, S. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01889-7 · Cited by 438 · see citing works
The major health implications of social connection
Holt-Lunstad, J. (2021) · Current Directions in Psychological Science · doi:10.1177/0963721421999630 · Cited by 273 · see citing works
Christiansen, J., Qualter, P., Friis, K., Pedersen, S., Lund, R., Andersen, C., Bekker-Jeppesen, M., & Lasgaard, M. (2021) · Perspectives in Public Health · doi:10.1177/17579139211016077 · Cited by 241 · see citing works
Psychobiological factors of resilience and depression in late life
Laird, K. T., Krause, B., Funes, C., & Lavretsky, H. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0424-7 · Cited by 229 · see citing works
Social isolation: an underappreciated determinant of physical health
Holt-Lunstad, J., & Steptoe, A. (2022) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2021.07.012 · Cited by 216 · see citing works
Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., Navar, A. M., Taub, P. R., Toth, P. P., Virani, S. S., et al. (2020) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2020.100009 · Cited by 143 · see citing works
Yu, B., Steptoe, A., Chen, L.-J., Chen, Y.-H., Lin, C.-H., & Ku, P.-W. (2020) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000777 · Cited by 108 · see citing works
Elovainio, M., Lahti, J., Pirinen, M., Pulkki-Råback, L., Malmberg, A., Lipsanen, J., Virtanen, M., Kivimäki, M., & Hakulinen, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-053936 · Cited by 85 · see citing works
Self-citationImprovement of Social Isolation and Loneliness and Excess Mortality Risk in People With Obesity
Zhou, J., Tang, R., Wang, X., Li, X., Heianza, Y., & Qi, L. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.52824 · Cited by 68 · see citing works
Biological principles for music and mental health
Bowling, D. L. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02671-4 · Cited by 64 · see citing works
Joerin, A., Rauws, M., & Ackerman, M. L. (2019) · Cureus · doi:10.7759/cureus.3972 · Cited by 47 · see citing works
Loneliness: an incommunicable disease?
Franklin, J. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x712541 · Cited by 1 · see citing works
- Authors
- Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Jokela, M., Kivimäki, M., & Elovainio, M.
- Affiliations
- University of Helsinki (FI)
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Uppsala University (SE)
- Department of Epidemiology and Public Health, University College London, London, UK
- Corresponding author
- Hakulinen, Christian
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2018-03-27
- Volume
- 104
- Issue
- 18
- Pages
- 1536-1542
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2795121900
- Cited by
- 355
- References
- 29
- Citations by year
- 2026: 43 · 2025: 56 · 2024: 48 · 2023: 53 · 2022: 42 · 2021: 48 · 2020: 28 · 2019: 28 · 2018: 8
- FWCI
- 29.98
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-06-26)
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Heart (publishedVersion, other-oa)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- NordForsk
- Suomen Akatemia
- Helsinki Institute of Life Science fellowship
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- social isolation, loneliness, myocardial infarction, stroke, mortality, cardiovascular risk factors, social determinants of health, UK Biobank, men and women comparison, post-stroke mortality
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, United Kingdom, Humans, Loneliness, Male, Middle Aged, Myocardial Infarction, Registries, Retrospective Studies, Risk Factors, Social Isolation, Time Factors, Incidence, Survival Rate, Risk Assessment, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
