Loneliness, social isolation, and cardiovascular disease among nonveteran and veteran women

Abstract

We examined the prospective associations of social isolation and loneliness with incident cardiovascular disease (CVD) among aging nonveteran and veteran women, and effect modification by veteran status. Participants with no history of myocardial infarction (MI), stroke, coronary heart disease (CHD), or coronary heart failure from the Women’s Health Initiative Extension Study II self-reported social isolation, loneliness, health behaviors, health status, and veteran status. CVD and CVD subevents were physician adjudicated. Hazard ratios (HR) and 95% confidence intervals (CI) for the Interquartile Range (IQR) in social isolation (IQR = 1) and loneliness (IQR=.33) were calculated using Cox proportional hazard models adjusting for sociodemographic, health behavior, and health status characteristics. Veteran status was tested as an effect modifier. Among 52,442 women (Mean age = 79 ± 6.1; veterans n = 1023; 89.2% non-Hispanic White), 3579 major CVD events occurred over an average 5.8 follow-up years. Compared to nonveterans, veteran women reported higher levels of social isolation (p < .01) and loneliness (p < .01). The CVD HR was 1.07 (95% CI, 1.04–1.10) for the IQR in social isolation and 1.03 (95% CI, 1.10–1.06) for the IQR in loneliness. The HR for the IQR in both social isolation and loneliness was 1.10 (95% CI, 1.05–1.15). Social isolation was associated with CHD (HR = 1.12; 95% CI, 1.03–1.21). The CHD HR for the IQR in social isolation was 1.12 (95% CI, 1.03–1.21). Associations did not differ by veteran status (all p-interactions > 0.08). Findings suggest that the adverse associations of social isolation and loneliness with CVD are similar among veteran and nonveteran women.

Keywords:

• Aging women
• cardiovascular disease
• loneliness
• social isolation

Acknowledgments

The authors thank the Women's Health Initiative (WHI) participants, staff, and investigators. The short list of WHI investigators can be found at the following site: https://www‐whi‐org.s3.us‐west‐2.amazonaws.com/wp‐content/uploads/WHI‐Investigator‐Short‐List.pdf. The full list of WHI investigators can be found at the following site: https://s3‐us‐west‐2.amazonaws.com/www‐whi‐org/wp‐content/uploads/WHI‐Investigator‐Long‐List.pdf.

Disclosure statement

There are no conflicts of interest to disclose.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, NMY. The data are not publicly available due to restrictions containing information that could compromise the privacy of research participants.

Additional information

Funding

This work was supported by the National Heart, Blood, Lung Institute (K01 HL159348-01) to N.M.Y and National Institute on Aging T32 Predoctoral Training Fellowship (T32 AG058529) to A.I.B.P. This work was also supported by National Institutes of Health, National Cancer Institute Grants (R01CA230440, R01CA253028) to C.K. and by the American Cancer Society ACS Research Investigator Award (RSG-16-167-01-CPPB) to C.K. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.