Increased Mortality Risk Among Socially Isolated Older Adults With COPD

Socially isolated older adults with chronic obstructive pulmonary disease (COPD) had an increased risk of mortality compared to their non-socially isolated counterparts, a retrospective cohort study found.

Participants with COPD and social isolation had an adjusted hazard ratio (HR) for death of 1.35 (95% CI 1.04-1.75) compared to those without social isolation, Angela O. Suen, MD, of the University of California San Francisco, and colleagues reported in a research letter in JAMA Internal Medicine.

Median survival time was also lower in those who were socially isolated (7 years vs 9.1 years), as was the 5-year survival rate (62.9% vs 71.1%) compared with the non-socially isolated.

“These results suggest that the impact of social isolation in COPD are consistent with those of other life limiting conditions in older adults, including hospitalization for critical illness, severe heart failure, and stroke,” Suen and colleagues wrote.

Social isolation is known to be linked to poor health outcomes and mortality among adults 65 and older. Around one-fifth of those with COPD experience social isolation, according to the authors, perhaps because of reduced physical function and breathlessness. However, few studies have examined mortality in U.S. adults with COPD, specifically.

A previous study found a smaller absolute risk difference in 5-year survival linked to isolation (93% vs 95% of adults that were not isolated). The authors hypothesized that the increased risk of mortality they found among adults with COPD could be due to less access to support for managing symptoms associated with the condition, like breathlessness, functional limitations, and complex medical regimens. To address social isolation in this group, they suggested “expanding interdisciplinary efforts to reduce or prevent social isolation” with interventions like group-based pulmonary rehabilitation, support groups, or community meal and exercise programs.

“Moreover, addressing social isolation may enhance well-being and resources to proactively plan for health crises,” the authors added.

Researchers used data for adults 51 and older from 2006-2022 from the Health and Retirement Survey (HRS), which is conducted every 2 years until death. They used a previously published social isolation scale, which gave 1 point each for being unmarried; living alone; having no social contact with children, family, or friends; and having no community participation, with ≥3 points on a 6-point scale indicating social isolation. COPD was self-reported, and all-cause mortality came from HRS date-of-death measures.

Participants were included if they reported COPD and responded to at least three social isolation questions. Associations between social isolation and all-cause mortality were adjusted for age, sex, race and ethnicity, education, comorbidities (high blood pressure, cancer, diabetes, stroke, and heart disease), cognitive impairment, depression, and tobacco use.

A total of 1,241 participants were included; mean age was 68.4 and 59.3% were female. Of these, 23.6% reported experiencing social isolation. The median follow-up was 4.4 years, after which 43.4% of total participants had died.

Study limitations included the self-report of COPD, which could have captured other chronic lung diseases like interstitial lung disease.

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