Social Isolation and Incident Heart Failure Hospitalization in Older Women: Women's Health Initiative Study Findings

Crystal W Cené, Xiaoyan Iris Leng, Khushnood Faraz, Matthew Allison, Khadijah Breathett, Chloe Bird, Mace Coday, Giselle Corbie-Smith, Randi Foraker, Nkechinyere N Ijioma, Milagros C Rosal, Shawnita Sealy-Jefferson, Tetyana P Shippee, Candyce H Kroenke, Crystal W Cené, Xiaoyan Iris Leng, Khushnood Faraz, Matthew Allison, Khadijah Breathett, Chloe Bird, Mace Coday, Giselle Corbie-Smith, Randi Foraker, Nkechinyere N Ijioma, Milagros C Rosal, Shawnita Sealy-Jefferson, Tetyana P Shippee, Candyce H Kroenke

Abstract

Background The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potential mediator and age and race and ethnicity as effect modifiers. Methods and Results This study included 44 174 postmenopausal women of diverse race and ethnicity from the WHI (Women's Health Initiative) study who underwent annual assessment for HF adjudication from baseline enrollment (1993-1998) through 2018. We conducted a mediation analysis to examine depressive symptoms as a potential mediator and further examined effect modification by age and race and ethnicity. Incident HF requiring hospitalization was the main outcome. Social isolation was a composite variable based on marital/partner status, religious ties, and community ties. Depressive symptoms were assessed using CES-D (Center for Epidemiology Studies-Depression). Over a median follow-up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08-1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07-1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF. Conclusions Socially isolated older women are at increased risk for developing HF, independent of traditional HF risk factors. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT00000611.

Keywords: heart failure; older adults; social isolation; women.

Figures

Figure 1. Analytic sample.
Figure 1. Analytic sample.
BMI indicates body mass index; and HF, heart failure; SF36, Short Form 36.
Figure 2. Kaplan–Meier product limit estimate of…
Figure 2. Kaplan–Meier product limit estimate of the cumulative incidence of heart failure hospitalization over time by social isolation status (socially isolated vs nonisolated) at baseline.
Figure 3. Conceptual model of direct, mediating,…
Figure 3. Conceptual model of direct, mediating, and moderating effects of social isolation on incident HF hospitalization in 36 457 older women (mean age, 62 years) from the WHI (Women's Health Initiative) study over mean follow‐up of 15 years.

References

    1. Seeman TE. Social ties and health: the benefits of social integration. Ann Epidemiol. 1996;6:442–451. doi: 10.1016/S1047-2797(96)00095-6
    1. National Academies of Sciences, Engineering, and Medicine . Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press; 2020.
    1. Pantell M, Rehkopf D, Jutte D, Syme SL, Balmes J, Adler N. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health. 2013;103:2056–2062. doi: 10.2105/AJPH.2013.301261
    1. Rod NH, Andersen I, Prescott E. Psychosocial risk factors and heart failure hospitalization: a prospective cohort study. Am J Epidemiol. 2011;174:672–680. doi: 10.1093/aje/kwr144
    1. Cene CW, Loehr L, Lin FC, Hammond WP, Foraker RE, Rose K, Mosley T, Corbie‐Smith G. Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study. Eur J Heart Fail. 2012;14:748–753. doi: 10.1093/eurjhf/hfs064
    1. Solway E, Piette J, Kirch M, Singer D, Kullgren J, Malani P. Loneliness and health among older adults: results form the University of Michigan National Poll on Healthy Aging. Innov Aging. 2019;3(Suppl 1):S600–S601. doi: 10.1093/geroni/igz038.2233
    1. Leigh‐Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, Caan W. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157–171. doi: 10.1016/j.puhe.2017.07.035
    1. Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34:337–354. doi: 10.1146/annurev-publhealth-031912-114452
    1. Xia N, Li H. Loneliness, social isolation, and cardiovascular health. Antioxid Redox Signal. 2018;28:837–851. doi: 10.1089/ars.2017.7312
    1. Grant N, Hamer M, Steptoe A. Social isolation and stress‐related cardiovascular, lipid, and cortisol responses. Ann Behav Med. 2009;37:29–37. doi: 10.1007/s12160-009-9081-z
    1. Santini ZI, Koyanagi A, Tyrovolas S, Mason C, Haro JM. The association between social relationships and depression: a systematic review. J Affect Disord. 2015;175:53–65. doi: 10.1016/j.jad.2014.12.049
    1. Schwarzbach M, Luppa M, Forstmeier S, König HH, Riedel‐Heller SG. Social relations and depression in late life—a systematic review. Int J Geriatr Psychiatry. 2014;29:1–21. doi: 10.1002/gps.3971
    1. Women's Health Initiative . Researchers. Available at: . Accessed September 1, 2021.
    1. Ritenbaugh C, Patterson RE, Chlebowski RT, Caan B, Fels‐Tinker L, Howard B, Ockene J. The Women's Health Initiative Dietary Modification trial: overview and baseline characteristics of participants. Ann Epidemiol. 2003;13:S87–S97. doi: 10.1016/S1047-2797(03)00044-9
    1. Stefanick ML, Cochrane BB, Hsia J, Barad DH, Liu JH, Johnson SR. The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. Ann Epidemiol. 2003;13:S78–S86. doi: 10.1016/S1047-2797(03)00045-0
    1. Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M. The Women's Health Initiative observational study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol. 2003;13:S107–S121. doi: 10.1016/S1047-2797(03)00047-4
    1. Anderson GL, Manson J, Wallace R, Lund B, Hall D, Davis S, Shumaker S, Wang C‐Y, Stein E, Prentice RL. Implementation of the Women's Health Initiative study design. Ann Epidemiol. 2003;13:S5–S17. doi: 10.1016/S1047-2797(03)00043-7
    1. Heckbert SR, Kooperberg C, Safford MM, Psaty BM, Hsia J, McTiernan A, Gaziano JM, Frishman WH, Curb JD. Comparison of self‐report, hospital discharge codes, and adjudication of cardiovascular events in the Women’s Health Initiative. Am J Epidemiol. 2004;160:1152–1158. doi: 10.1093/aje/kwh314
    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. doi: 10.1093/oxfordjournals.aje.a112674
    1. Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J. Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol. 1987;126:714–723.
    1. Berkman LF, Glass T. Conceptual model of how social networks impact health. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York: Oxford University Press; 2000:144.
    1. Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10:37–48. doi: 10.1097/00001648-199901000-00008
    1. Chamberlain AM, Manemann SM, Dunlay SM, Spertus JA, Moser DK, Berardi C, Kane RL, Weston SA, Redfield MM, Roger VL. Self‐rated health predicts healthcare utilization in heart failure. J Am Heart Assoc. 2014;3:e000931. doi: 10.1161/JAHA.114.000931
    1. Ware J Jr, Kosinski M, Keller SD. A 12‐Item Short‐Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003
    1. Pandey A, LaMonte M, Klein L, Ayers C, Psaty BM, Eaton CB, Allen NB, de Lemos JA, Carnethon M, Greenland P, et al. Relationship between physical activity, body mass index, and risk of heart failure. J Am Coll Cardiol. 2017;69:1129–1142. doi: 10.1016/j.jacc.2016.11.081
    1. Karim J, Weisz R, Bibi Z, ur Rehman S. Validation of the eight‐item Center for Epidemiologic Studies Depression Scale (CES‐D) among older adults. Curr Psychol. 2015;34:681–692. doi: 10.1007/s12144-014-9281-y
    1. Gorji MH, Fatahian A, Farsavian A. The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: a systematic review and meta‐analysis of observational studies. Gen Hosp Psychiatry. 2019;60:27–36. doi: 10.1016/j.genhosppsych.2019.07.002
    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. doi: 10.1136/heartjnl-2015-308790
    1. Van Tilburg T. Losing and gaining in old age: changes in personal network size and social support in a four‐year longitudinal study. J Gerontol B Psychol Sci Soc Sci. 1998;53:S313–S323. doi: 10.1093/geronb/53B.6.S313
    1. Eaton CB, Abdulbaki AM, Margolis KL, Manson JE, Limacher M, Klein L, Allison MA, Robinson JG, Curb JD, Martin LA, et al. Racial and ethnic differences in incident hospitalized heart failure in postmenopausal women: the Women's Health Initiative. Circulation. 2012;126:688–696. doi: 10.1161/CIRCULATIONAHA.111.066688
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, et al. Heart disease and stroke statistics‐2014 update. Circulation. 2014;129:e28–e292. doi: 10.1161/01.cir.0000441139.02102.80
    1. Cornwell B, Laumann EO, Schumm LP. The social connectedness of older adults: a national profile. Am Sociol Rev. 2008;73:185–203. doi: 10.1177/000312240807300201
    1. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: a meta‐analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48:1527–1537. doi: 10.1016/j.jacc.2006.06.055
    1. Ogilvie RP, Everson‐Rose SA, Longstreth W Jr, Rodriguez CJ, Diez‐Roux AV, Lutsey PL. Psychosocial factors and risk of incident heart failure: the Multi‐Ethnic Study of Atherosclerosis. Circ Heart Fail. 2016;9:e002243. doi: 10.1161/CIRCHEARTFAILURE.115.002243
    1. Abramson J, Berger A, Krumholz HM, Vaccarino V. Depression and risk of heart failure among older persons with isolated systolic hypertension. Arch Intern Med. 2001;161:1725–1730. doi: 10.1001/archinte.161.14.1725
    1. May HT, Horne BD, Carlquist JF, Sheng X, Joy E, Catinella AP. Depression after coronary artery disease is associated with heart failure. J Am Coll Cardiol. 2009;53:1440–1447. doi: 10.1016/j.jacc.2009.01.036
    1. Penwell LM, Larkin KT. Social support and risk for cardiovascular disease and cancer: a qualitative review examining the role of inflammatory processes. Health Psychol Rev. 2010;4:42–55. doi: 10.1080/17437190903427546
    1. Umberson D, Karas MJ. Social relationships and health: a flashpoint for health policy. J Health Soc Behav. 2010;51:S54–S66. doi: 10.1177/0022146510383501
    1. Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Hall A, Koller A, Marzilli M, Pries A, Bugiardini R. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Position paper from the working group on coronary pathophysiology and microcirculation of the European Society of Cardiology. Cardiovasc Res. 2011;90:9–17. doi: 10.1093/cvr/cvq394
    1. Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records . Capturing Social and Behavioral Domains in Electronic Health Records. National Academies Press; 2014.
    1. Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011;11:647. doi: 10.1186/1471-2458-11-647
    1. Gardiner C, Geldenhuys G, Gott M. Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community. 2018;26:147–157. doi: 10.1111/hsc.12367

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir