Social Isolation Linked to Increased Mortality in Patients With COPD

Social isolation is independently associated with increased mortality in patients with chronic obstructive pulmonary disease (COPD), according to a research letter published in JAMA Internal Medicine.¹

Social isolation, an objective state of limited to no social contact, has been linked to poor health outcomes and mortality among those aged 65 or older. Also, about 1 in 5 people with COPD experience social isolation, which is about twice as much as older adults overall. The researchers attributed this increase in social isolation to disease features, like breathlessness and reduced physical function.

However, the association of social isolation in COPD with downstream outcomes, like mortality, has not been examined. Consequently, the researchers investigated the association between social isolation and all-cause mortality in a nationally representative cohort of US adults with COPD.

Social isolation significantly increases the risk of mortality in patients with chronic obstructive pulmonary disease (COPD). | Image Credit: amazing studio - stock.adobe.com

They used data from the Health and Retirement Survey (HRS), focusing on adults aged 51 or older, with the dataset spanning 2006 to 2022.² Additionally, the researchers used a previously published social isolation scale, which included metrics like being unmarried, lacking community participation, living alone, and having no social contact with children, family, or friends.¹

Individuals received 1 point for each applicable metric, with scores ranging from 0 to 6. Those with 3 points or more were classified as experiencing social isolation. The researchers noted that participants were included at the first available wave in which they self-reported COPD and answered at least 3 questions related to social isolation.

All-cause mortality was determined using HRS date-of-death measures. Cox proportional hazard models were then used to determine the association between social isolation and all-cause mortality, adjusting for age, race, sex, and ethnicity, which have previously been associated with social isolation.

The study population consisted of 1241 participants, with a mean (SD) age of 68.4 (9.8) years; the majority was female (59.3%). Of these participants, 293 (23.6%) reported experiencing social isolation. Additionally, 539 participants (43.4%) died after a median follow-up of 4.4 years (range, 0.1-14.6 years).

Those with COPD and social isolation were at an increased risk of death (unadjusted HR, 1.35; 95% CI, 1.08-169; adjusted HR, 1.35; 95% CI, 1.04-1.75) than those without social isolation. Therefore, median survival time was lower among socially isolated participants (7.0 years; 95% CI, 5.8-8.2) vs those not socially isolated (9.1 years; 95% CI, 8.3-10.4). Similarly, the 5-year survival rate among socially isolated participants (62.9%; 95% CI, 56.6-68.6) was lower than that of those not socially isolated (71.1%; 95% CI, 67.7-74.1).

“We hypothesize that social isolation may increase mortality risk in COPD by limiting access to necessary support and resources for managing debilitating symptoms such as breathlessness, functional limitations, and complex medical regimens, particularly after hospital or intensive care unit stays,” the authors wrote.

Consequently, the researchers emphasized that addressing social isolation through expanded interdisciplinary efforts could improve well-being and provide resources to help proactively plan for health crises. Potential interventions include support groups, group-based pulmonary rehabilitation, and behavioral activation to promote self-efficacy.

Lastly, the researchers acknowledged their limitations, one being that patients self-reported COPD diagnoses. This could capture other less common chronic lung diseases, like interstitial lung disease. Despite their limitations, they expressed confidence in their findings, using them to suggest areas for further research.

“Future studies should investigate strategies to reduce social isolation among patients with COP and whether these efforts may improve health outcomes,” the authors concluded.

References

1. Suen AO, Iyer AS, Cenzer I, et al. Social isolation and mortality in adults with chronic obstructive pulmonary disease. JAMA Intern Med. doi:10.1001/jamainternmed.2024.5940
2. Sonnega A, Faul JD, Ofstedal MB, Langa KM, Phillips JW, Weir DR. Cohort profile: the health and retirement Study (HRS). Int J Epidemiol. 2014;43(2):576-585. doi:10.1093/ije/dyu067