Association between social capital and mortality among community-dwelling older adults in Myanmar 2018-2022: a prospective cohort study.

Abstract

Background: Healthy aging is crucial in Asia given its rapidly aging society. Social capital, which refers to the resources derived from social networks, norms, and trust that facilitate cooperation and collective action within a community or society, has demonstrated health benefits for older adults. However, its impact varies by country. Most research focuses on high-income countries, with little attention on low- and middle-income countries.

Methods: This prospective cohort study examined the effects of social capital on all-cause mortality among older adults in Myanmar from 2018 to 2022, using structured questionnaires based on the Japan Gerontological Evaluation Study. Multistage random sampling and face-to-face interviews were conducted with community-dwelling older adults aged 60 and above in Yangon and Bago in 2018. Subsequently, three waves of follow-up telephone surveys were conducted in 2020, 2021, and 2022. The questionnaires evaluated three components of social capital: civic participation, social cohesion, and social support, alongside baseline demographic information. Their impact on all-cause mortality was assessed using the Cox proportional hazards model with multiple imputations, adjusting for potential confounders including age, gender, body mass index, self-rated health, socioeconomic status, lifestyle, illness, and residential area.

Results: A total of 1200 individuals were followed for an average of 2.6 years (3123 person-years), with 143 all-cause deaths observed among 1031 participants. Bivariate analyses showed that participants who died were more likely to be older, underweight, have shorter daily walking times, live in Bago, and have less social support. Higher social support was significantly associated with lower mortality after adjusting for all covariates (HR = 0.80, 95% CI 0.69-0.94). Specifically, instrumental support, defined as the exchange of practical assistance, such as receiving or providing care during illness, was found to be protectively associated with mortality. When stratified by residential area, significant associations were found only in Bago, a rural area. Among older adults in Myanmar, instrumental support was a more prominent protector against all-cause mortality than emotional support, especially in rural areas.

Conclusions: Our findings indicate that social support networks play an important role in the survival of older adults in Myanmar, even under unstable social conditions.