{"title":"孤独感对85岁前美国中老年人群死亡率的预测作用：一项10年回顾性队列研究。","authors":"Hui-Ying Fan, Mu-Rui Zheng, Qinge Zhang, Sha Sha, Yuan Feng, Zhaohui Su, Teris Cheung, Gabor S Ungvari, Lloyd Balbuena, Yu-Tao Xiang","doi":"10.1017/S2045796025100188","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Loneliness is a common public health concern, particularly among mid- to later-life adults. However, its impact on early mortality (deaths occurring before reaching the oldest old age of 85 years) remains underexplored. This study examined the predictive role of loneliness on early mortality across different age groups using data from the Health and Retirement Study (HRS).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the 2010-2020 waves of the HRS, restricted to participants aged 50-84 years at baseline. Loneliness was measured using the 11-item UCLA Loneliness Scale, categorized into four levels: low/no loneliness (scores 11-13), mild loneliness (14-16), moderate loneliness (17-20) and severe loneliness (21-33). Cox proportional hazards models and time-varying Cox regression models with age as the time scale were created to evaluate the relationship between loneliness and early mortality, adjusting for sociodemographic, lifestyle, and physical and mental health factors.</p><p><strong>Results: </strong>Among 6,392 participants, the overall mortality rate before the age of 85 years was 19.1 per 1,000 person-years. A dose-response relationship was observed, with moderate and severe loneliness associated with 23% (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI] = 1.02-1.48) and 36% (aHR: 1.36, 95% CI = 1.13-1.65) higher mortality risk, respectively. Significant associations existed for the 65-74-year-old (aHR = 1.37, 95% CI = 1.03-1.83) and 75-84-year-old (aHR = 1.77, 95% CI = 1.23-2.56) age groups in the fully-adjusted models, but not for the 50-64-year-old age group. Time-varying Cox models showed a stronger association for severe loneliness (aHR = 1.65, 95% CI = 1.37-1.99).</p><p><strong>Conclusions: </strong>Loneliness is a significant predictor of mortality among older adults. Preventive and interventional programs targeting loneliness may promote healthy ageing.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"34 ","pages":"e48"},"PeriodicalIF":6.1000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450537/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictive role of loneliness on mortality before the age 85 years among mid- to later-life adults in the United States: a 10-year retrospective cohort study.\",\"authors\":\"Hui-Ying Fan, Mu-Rui Zheng, Qinge Zhang, Sha Sha, Yuan Feng, Zhaohui Su, Teris Cheung, Gabor S Ungvari, Lloyd Balbuena, Yu-Tao Xiang\",\"doi\":\"10.1017/S2045796025100188\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Loneliness is a common public health concern, particularly among mid- to later-life adults. However, its impact on early mortality (deaths occurring before reaching the oldest old age of 85 years) remains underexplored. This study examined the predictive role of loneliness on early mortality across different age groups using data from the Health and Retirement Study (HRS).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the 2010-2020 waves of the HRS, restricted to participants aged 50-84 years at baseline. Loneliness was measured using the 11-item UCLA Loneliness Scale, categorized into four levels: low/no loneliness (scores 11-13), mild loneliness (14-16), moderate loneliness (17-20) and severe loneliness (21-33). Cox proportional hazards models and time-varying Cox regression models with age as the time scale were created to evaluate the relationship between loneliness and early mortality, adjusting for sociodemographic, lifestyle, and physical and mental health factors.</p><p><strong>Results: </strong>Among 6,392 participants, the overall mortality rate before the age of 85 years was 19.1 per 1,000 person-years. A dose-response relationship was observed, with moderate and severe loneliness associated with 23% (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI] = 1.02-1.48) and 36% (aHR: 1.36, 95% CI = 1.13-1.65) higher mortality risk, respectively. Significant associations existed for the 65-74-year-old (aHR = 1.37, 95% CI = 1.03-1.83) and 75-84-year-old (aHR = 1.77, 95% CI = 1.23-2.56) age groups in the fully-adjusted models, but not for the 50-64-year-old age group. Time-varying Cox models showed a stronger association for severe loneliness (aHR = 1.65, 95% CI = 1.37-1.99).</p><p><strong>Conclusions: </strong>Loneliness is a significant predictor of mortality among older adults. Preventive and interventional programs targeting loneliness may promote healthy ageing.</p>\",\"PeriodicalId\":11787,\"journal\":{\"name\":\"Epidemiology and Psychiatric Sciences\",\"volume\":\"34 \",\"pages\":\"e48\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450537/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Epidemiology and Psychiatric Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1017/S2045796025100188\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiology and Psychiatric Sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1017/S2045796025100188","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
摘要
目的：孤独是一种常见的公共健康问题，特别是在中老年成年人中。然而，它对早期死亡（在达到85岁高龄之前死亡）的影响仍未得到充分探讨。本研究利用健康与退休研究（HRS）的数据，研究了孤独对不同年龄组早期死亡率的预测作用。方法：采用2010-2020年HRS数据进行回顾性队列研究，受试者基线年龄为50-84岁。孤独感的测量采用UCLA孤独感量表，分为四个等级：低/无孤独感（11-13分）、轻度孤独感（14-16分）、中度孤独感（17-20分）和重度孤独感（21-33分）。建立Cox比例风险模型和以年龄为时间尺度的时变Cox回归模型来评估孤独与早期死亡率之间的关系，并对社会人口统计学、生活方式和身心健康因素进行调整。结果：在6392名参与者中，85岁前的总死亡率为19.1 / 1000人年。观察到剂量-反应关系，中度和重度孤独感分别与23%（校正风险比[aHR]: 1.23, 95%可信区间[CI] = 1.02-1.48）和36% （aHR: 1.36, 95% CI = 1.13-1.65）的高死亡风险相关。在完全调整模型中，65-74岁年龄组（aHR = 1.37, 95% CI = 1.03-1.83）和75-84岁年龄组（aHR = 1.77, 95% CI = 1.23-2.56）存在显著相关性，但50-64岁年龄组不存在显著相关性。随时间变化的Cox模型显示，重度孤独感的相关性更强（aHR = 1.65, 95% CI = 1.37 ~ 1.99）。结论：孤独是老年人死亡率的重要预测因子。针对孤独的预防和干预方案可以促进健康老龄化。
Predictive role of loneliness on mortality before the age 85 years among mid- to later-life adults in the United States: a 10-year retrospective cohort study.
Aims: Loneliness is a common public health concern, particularly among mid- to later-life adults. However, its impact on early mortality (deaths occurring before reaching the oldest old age of 85 years) remains underexplored. This study examined the predictive role of loneliness on early mortality across different age groups using data from the Health and Retirement Study (HRS).
Methods: A retrospective cohort study was conducted using data from the 2010-2020 waves of the HRS, restricted to participants aged 50-84 years at baseline. Loneliness was measured using the 11-item UCLA Loneliness Scale, categorized into four levels: low/no loneliness (scores 11-13), mild loneliness (14-16), moderate loneliness (17-20) and severe loneliness (21-33). Cox proportional hazards models and time-varying Cox regression models with age as the time scale were created to evaluate the relationship between loneliness and early mortality, adjusting for sociodemographic, lifestyle, and physical and mental health factors.
Results: Among 6,392 participants, the overall mortality rate before the age of 85 years was 19.1 per 1,000 person-years. A dose-response relationship was observed, with moderate and severe loneliness associated with 23% (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI] = 1.02-1.48) and 36% (aHR: 1.36, 95% CI = 1.13-1.65) higher mortality risk, respectively. Significant associations existed for the 65-74-year-old (aHR = 1.37, 95% CI = 1.03-1.83) and 75-84-year-old (aHR = 1.77, 95% CI = 1.23-2.56) age groups in the fully-adjusted models, but not for the 50-64-year-old age group. Time-varying Cox models showed a stronger association for severe loneliness (aHR = 1.65, 95% CI = 1.37-1.99).
Conclusions: Loneliness is a significant predictor of mortality among older adults. Preventive and interventional programs targeting loneliness may promote healthy ageing.
期刊介绍：
Epidemiology and Psychiatric Sciences is a prestigious international, peer-reviewed journal that has been publishing in Open Access format since 2020. Formerly known as Epidemiologia e Psichiatria Sociale and established in 1992 by Michele Tansella, the journal prioritizes highly relevant and innovative research articles and systematic reviews in the areas of public mental health and policy, mental health services and system research, as well as epidemiological and social psychiatry. Join us in advancing knowledge and understanding in these critical fields.
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