National Prevalence of Social Isolation and Loneliness in Adults with Chronic Obstructive Pulmonary Disease

Abstract

Rationale: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet they have not been defined in people with chronic obstructive pulmonary disease (COPD). Objective: To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD. Methods: This is a cross-sectional study of community-dwelling adults aged ⩾50 years in the nationally representative HRS (Health and Retirement Study) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: 1) no COPD; 2) COPD; and 3) COPD on oxygen. Social isolation was defined using a nine-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-Item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both. Results: Participants (n = 10,384) were on average 68 years old (standard deviation, ±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%; COPD: 16%; COPD on oxygen: 20%; P < 0.05) and loneliness (no COPD: 11%; COPD: 18%; COPD on oxygen: 22%; P < 0.001). In those with COPD, characteristics associated with social isolation (P < 0.05) included sex (men: 22%; women: 13%), non-Hispanic White ethnicity (White: 19%; Black: 7%), low net worth (<$6,000: 32%; $81,001-$239,000: 10%), depression (depression: 24%; no depression: 14%), having difficulty with one or more activities of daily living (one or more difficulty: 22%; no difficulty: 14%), and current cigarette use (current: 24%; never: 13%). Characteristics associated with loneliness (P < 0.05) included younger age (50-64 yr: 22%; 75-84 yr: 12%), being single (single: 32%; married: 12%), depression (depression: 36%; no depression: 13%), having difficulty with one or more activities of daily living (one or more difficulty: 29%; no difficulty: 15%), diabetes (diabetes: 26%; no diabetes: 17%), and heart disease (heart disease 23%; no heart disease: 17%). Conclusions: Nearly one in six adults with COPD experience social isolation, and one in five experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared with the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions.

Keywords: respiratory insufficiency; social determinants of health; social environment; social support.

Figure 1.

The adjusted prevalence of social isolation, frequent loneliness, and both social isolation and frequent loneliness by chronic obstructive pulmonary disease (COPD) status. Rates represent the model-based probabilities adjusted for age, sex, race and ethnicity, marital status, and net worth. Error bars represent the 95% confidence intervals. All displayed comparisons reached a significance threshold of P < 0.05. P values represent the overall association across COPD groups with social isolation, loneliness, or both in multiple logistic regression models using joint Wald tests. Social isolation was defined with a score ⩽2. Frequent loneliness is defined using the validated 3-Item UCLA Loneliness Scale, where a score of ⩾4 indicates frequent loneliness. COPD and oxygen use are self-reported.

Figure 2.

The distribution of social isolation subscales by COPD status. (A) Household and core contacts subscale. (B) Social network interaction subscale. (C) Community engagement subscale. Unless noted with an asterisk, all displayed comparisons reached a significance threshold of P < 0.05. COPD = chronic obstructive pulmonary disease.

Figure 3.

Identified subgroups at risk for (A) social isolation and (B) loneliness among persons with chronic obstructive pulmonary disease (n = 1,100). All displayed comparisons reached a significance threshold of P < 0.05. For ordinal categorical variables, P values were derived from joint Wald tests, which provide an overall test of significance. ADL = activities of daily living.