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      The association of multimorbidity, loneliness, social exclusion and network size: findings from the population-based German Ageing Survey

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          Abstract

          Background

          The aim of this study was to examine the association between multimorbidity and (i) loneliness, (ii) social exclusion and (iii) network size, respectively.

          Methods

          Cross-sectional data from a German representative sample of community-dwelling adults aged 40 and over was used ( N = 7604). Multimorbidity was indicated with the presence of two or more diseases. Self-rated loneliness was assessed with a short form of the validated De Jong Gierveld Loneliness Scale and social exclusion was measured with a validated scale developed by Bude and Lantermann. Counts of important people in regular contact represented the network size of respondents.

          Results

          Multimorbidity was present in 68% of the sample. While controlling for potential confounders, multiple linear regression analysis yielded that multimorbidity was associated with increased loneliness (b = 0.08; p < 0.001) and increased social exclusion (b = 0.10; p < 0.01). Multimorbidity was also associated with an increased network size (b = 0.27; p < 0.001).

          Conclusion

          While there was an association between multimorbidity and increased social exclusion as well as increased loneliness, regressions also revealed an association between multimorbidity and an increased network size. Although the association between multimorbidity and our outcome measures is weak, its complex nature should be investigated further using a longitudinal approach.

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          Most cited references35

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          Being alone in later life: loneliness, social isolation and living alone

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            Social isolation, loneliness and their relationships with depressive symptoms: A population-based study

            Objectives To assess the relationship between various social isolation indicators and loneliness, and to examine the differential associations that social isolation indicators, loneliness have with depressive symptoms. Methods Baseline data for 1,919 adults (aged 21 years and above) from a representative health survey in the Central region of Singapore was used for this study. The association between social isolation indicators (marital status, living arrangement, social connectedness with relatives and friends) and loneliness (the three-item UCLA Loneliness) were assessed, and their differential associations with depressive symptoms (the Patient Health Questionnaire-9) were examined using multiple linear regression, controling for relevant covariates. Results There was significant overlap between loneliness and social isolation. Social connectedness with relatives and friends were mildly correlated with loneliness score (|r| = 0.14~0.16). Social isolation in terms of weak connectedness with relatives and with friends and loneliness were associated with depressive symptoms even after controling for age, gender, employment status and other covariates. The association of loneliness with depressive symptoms (β = 0.33) was independent of and stronger than that of any social isolation indicators (|β| = 0.00~0.07). Conclusions The results of the study establishes a significant and unique association of different social isolation indicators and loneliness with depressive symptoms in community-dwelling adults aged 21 and above.
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              Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women

              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.
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                Author and article information

                Contributors
                k.kristensen@uke.de
                h.koenig@uke.de
                a.hajek@uke.de
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                28 October 2019
                28 October 2019
                2019
                : 19
                : 1383
                Affiliations
                ISNI 0000 0001 2180 3484, GRID grid.13648.38, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, , University Medical Center Hamburg-Eppendorf, ; Martinistraße 52, 20246 Hamburg, Germany
                Author information
                http://orcid.org/0000-0001-8257-3002
                Article
                7741
                10.1186/s12889-019-7741-x
                6816194
                31660910
                995941ba-6a48-40a7-8c7e-f666c65cfc03
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 November 2018
                : 2 October 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                multimorbidity,loneliness,social exclusion,social isolation,network size
                Public health
                multimorbidity, loneliness, social exclusion, social isolation, network size

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