Written by Jessica Patella, ND. Study results show that lonely individuals had a higher risk of incident stroke, even after adjusting for potential confounders.
Stoke is one of the leading causes of death and long-term disability worldwide1,2. It has been suggested in research that loneliness may be a stroke risk factor but studies are limited1,3. An estimated 24.6% of older U.S. adults report loneliness, which was exacerbated by the COVID-19 pandemic1,4. Other research suggests occasional loneliness can be as high as 31-55% in older adults1,5. Recent longitudinal research suggests loneliness is a potential risk factor for stroke, which is modifiable1,3.
Although, loneliness is often included in questionnaires on depression, it is not a symptom of depression (DSM-IV)6. Loneliness is described subjectively as a gap between desired and available relationships1,7. For research purposes, loneliness was defined as a score of 6 or higher on the UCLA Loneliness Scale. It is also important to differentiate between loneliness and social isolation, which is the lack of social contact with others. Social isolation in the study was based on four domains of social activity including, marital status, volunteer activity, contact with children and neighbors (Berkman-Syme Social Network Index)1.
The research included two subsets of U.S. adults aged 50 and older that had not suffered from a stroke at baseline. All adults included were from the Health and Retirement Study (HRS) sponsored by the National Institute on Aging. The first subset included 12,161 adults that assessed loneliness at baseline only. The second subset included 8,936 adults that compared loneliness over two time points. In data collection, stroke included fatal or non-fatal stroke events. Reports of TIAs (transient ischemic attacks) were not coded as strokes1.
The results in the first subset (N=12,161) assessing loneliness at baseline were as follows:
- 1237 incident stokes during the 10-12 year follow-up
- A one-unit increase in loneliness score was associated with a five percent higher risk for incident stroke (HR 1.05, 95% CI 1.01-1.08)
The results in the second subset (N=8936) assessing change in loneliness were as follows:
- 601 incident strokes during the 6-8 year follow-up
- Compared to the consistently low group, the high loneliness group were younger (65.4 vs 67.6 years), had less than a high school education (25.6 vs 18.1%), and were less likely to engage in physical activity (73.4 vs 54.2%).
- Individuals categorized as lonely had a 25% higher risk of stroke (fully adjusted HR 1.25, 95% CI 1.06-1.47) compared to those not categorized as lonely.
- Individuals categorized as having “consistently high” loneliness across both times had a higher risk (HR 1.56, 95% CI 1.11-2.18) of stroke than with “consistently low” loneliness.
In all analyses, controlling for social isolation, did not change results.
In conclusion, lonely individuals had a higher risk of incident stroke, even after adjusting for potential confounders1. Previous research generally describes three mechanisms to explain how loneliness can impact stroke risk: physiological (blood pressure, adrenocortical activity, immunity), behavioral (poor medical adherence, smoking, alcohol use, sleep), and psychosocial (depression, anxiety, social interactions). This was the first study to address loneliness across multiple time frames and the risk of stroke. Researchers state that addressing loneliness may have an important role for the prevention of strokes1. Future research should address loneliness interventions and determine if they are effective in preventing strokes1.
Source: Soh, Yenee, Ichiro Kawachi, Laura D. Kubzansky, Lisa F. Berkman, and Henning Tiemeier. “Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of US older adults.” eClinicalMedicine 73 (2024).
© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
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Posted September 9, 2024.
Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health. She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at www.awarenesswellness.com.
References:
- Soh Y, Kawachi I, Kubzansky LD, Berkman LF, Tiemeier H. Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of US older adults. eClinicalMedicine. 2024;73
- Katan M, Luft A. Global Burden of Stroke. Semin Neurol. Apr 2018;38(2):208-211. doi:10.1055/s-0038-1649503
- Hodgson S, Watts I, Fraser S, Roderick P, Dambha-Miller H. Loneliness, social isolation, cardiovascular disease and mortality: a synthesis of the literature and conceptual framework. J R Soc Med. May 2020;113(5):185-192. doi:10.1177/0141076820918236
- Gao Q, Mak HW, Fancourt D. Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis. Soc Psychiatry Psychiatr Epidemiol. Mar 1 2024;doi:10.1007/s00127-024-02639-9
- Perissinotto CM, Stijacic Cenzer I, Covinsky KE. Loneliness in older persons: a predictor of functional decline and death. Arch Intern Med. Jul 23 2012;172(14):1078-83. doi:10.1001/archinternmed.2012.1993
- Weeks DG, Michela JL, Peplau LA, Bragg ME. Relation between loneliness and depression: a structural equation analysis. J Pers Soc Psychol. Dec 1980;39(6):1238-44. doi:10.1037/h0077709
- de Jong Gierveld J. A review of loneliness: concept and definitions, determinants and consequences. Reviews in clinical gerontology. 1998;8(1):73-80.
