Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 4;2(6):e260-e266.
doi: 10.1016/S2468-2667(17)30075-0. eCollection 2017 Jun.

Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study

Marko Elovainio  1 , Christian Hakulinen  2 , Laura Pulkki-Råback  3 , Marianna Virtanen  4 , Kim Josefsson  5 , Markus Jokela  6 , Jussi Vahtera  7 , Mika Kivimäki  8
Affiliations

Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study

Marko Elovainio et al. Lancet Public Health. .

Erratum in

Abstract

Background: The associations of social isolation and loneliness with premature mortality are well known, but the risk factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals.

Methods: We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation (a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors.

Findings: 466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65-1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20-1·33) after further adjustment for socioeconomic factors, health-related behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30-1·47), which reduced to 0·99 (95% CI 0·93-1·06) after full adjustment for baseline risks.

Interpretation: Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely.

Funding: Academy of Finland, NordForsk, and the UK Medical Research Council.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proportions of the social isolation–mortality association attributable to biological, behavioural, and psychological factors HR=hazard ratio. PERM=percentage of excess risk mediated. SHR=sub-hazard ratio. *Adjusted for age, sex, ethnic origin, and chronic disease.
Figure 2
Figure 2
Proportions of the loneliness–mortality association attributable to biological, behavioural, and psychological factors HR=hazard ratio. PERM=percentage of excess risk mediated. SHR=sub-hazard ratio. *Adjusted for age, sex, ethnic origin, and chronic disease.
See this image and copyright information in PMC

Comment in

References

    1. Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109:186–204. - PubMed
    1. House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988;241:540–545. - PubMed
    1. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316. - PMC - PubMed
    1. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10:227–237. - PubMed
    1. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009–1016. - PMC - PubMed

LinkOut - more resources