Social relationships and mortality risk: a meta-analytic review

Julianne Holt-Lunstad, Timothy B Smith, J Bradley Layton, Julianne Holt-Lunstad, Timothy B Smith, J Bradley Layton

Abstract

Background: The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.

Objectives: This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

Data extraction: Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

Results: Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).

Conclusions: The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram.
Figure 1. Flow diagram.
Figure 2. Contour enhanced funnel plot.
Figure 2. Contour enhanced funnel plot.
Figure 3. Forest plot of structural measures.
Figure 3. Forest plot of structural measures.
Figure 4. Forest plot of functional measures.
Figure 4. Forest plot of functional measures.
Figure 5. Forest plot of combined measures.
Figure 5. Forest plot of combined measures.
Figure 6. Comparison of odds (lnOR) of…
Figure 6. Comparison of odds (lnOR) of decreased mortality across several conditions associated with mortality.
Note: Effect size of zero indicates no effect. The effect sizes were estimated from meta analyses: ; A = Shavelle, Paculdo, Strauss, and Kush, 2008 ; B = Critchley and Capewell, 2003 ; C = Holman, English, Milne, and Winter, 1996 ; D = Fine, Smith, Carson, Meffe, Sankey, Weissfeld, Detsky, and Kapoor, 1994 ; E = Taylor, Brown, Ebrahim, Jollife, Noorani, Rees et al., 2004 ; F, G = Katzmarzyk, Janssen, and Ardern, 2003 ; H = Insua, Sacks, Lau, Lau, Reitman, Pagano, and Chalmers, 1994 ; I = Schwartz, 1994 .

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