Social relationship satisfaction and accumulation of chronic conditions and multimorbidity: a national cohort of Australian women

Abstract

Background: Social relationships are associated with mortality and chronic conditions. However, little is known about the effects of social relationship satisfaction on multiple chronic conditions (multimorbidity).

Aims: To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.

Methods: Data from 7 694 Australian women who were free from 11 chronic conditions at 45-50 years of age in 1996 were analysed. Five types of social relationship satisfaction (partner, family members, friends, work and social activities) were measured approximately every 3 years and scored from 0 (very dissatisfied) to 3 (very satisfied). Scores from each relationship type were summed to provide an overall satisfaction score (range: ≤5-15). The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.

Results: Over a 20-year period, 4 484 (58.3%) women reported multimorbidities. Overall, the level of social relationship satisfaction had a dose-response relationship with the accumulation of multimorbidities. Compared with women reporting the highest satisfaction (score 15), women with the lowest satisfaction (score ≤5) had the highest odds of accumulating multimorbidity (odds ratio (OR)= 2.35, 95% confidence interval (CI): 1.94 to 2.83) in the adjusted model. Similar results were observed for each social relationship type. Other risk factors, such as socioeconomic, behavioural and menopausal status, together explained 22.72% of the association.

Conclusions: Social relationship satisfaction is associated with the accumulation of multimorbidity, and the relationship is only partly explained by socioeconomic, behavioural and reproductive factors. Social connections (eg, satisfaction with social relationships) should be considered a public health priority in chronic disease prevention and intervention.

Keywords: ageism; psychosomatic medicine; social isolation; social networking.

Figure 1

Flowchart of the participant selection. ALSWH, Australian Longitudinal Study on Women’s Health.

Figure 2

Longitudinal transitions of women in different social relationship satisfaction scores. The bars with different colours show the distribution of social relationship satisfaction scores in each survey, and the links between bars show the flow from one category to another. Because the SAS procedure for this Sankey diagram cannot handle massive links between all categories, women with scores ≤7 were combined into one category.

Figure 3

Dose–response relationship between the overall social relationship satisfaction score and the accumulation of multimorbidity in age-adjusted and survey period-adjusted and fully adjusted models (n=7694). The age-adjusted and survey period-adjusted model was adjusted for age at baseline and surveys, while the fully adjusted model was adjusted for age, surveys, socioeconomic status, health behaviours and menopausal status. The results were estimated using the accumulation of multimorbidity in each survey (surveys 2–8) regressed on social relationship satisfaction scores in previous surveys (surveys 1–7), with reference to women who developed no or one condition only. Solid circles represent ORs, and vertical lines represent 95% CIs, with a score of 15 as the reference category. The dashed grey horizontal line represents an OR of 1. A score of overall satisfaction was constructed from the five social relationship satisfaction components (partners/closest person, family members, friends, work/career/study and social activities). OR, odds ratio; CI, confidence interval.