[Family status and social integration as predictors of mortality: a 5-year follow-up study of 55- to 74-year-old men and women in the Augsburg area]

Abstract

The relation between marital status, social integration and the mortality from all causes was examined in a population based cohort study. The 5-year-cohort consisted of 1,030 men and 957 women, aged 55-74 years who participated in the second MONICA Survey Augsburg, F.R.G., 1989/90 (MONICA = Monitoring of trends and determinants of cardiovascular disease). They were followed for mortality until 1995. Altogether 120 men and 45 women had died. Social integration was measured by an index of social ties. The index of social ties examined in these analyses includes (a) presence of a spouse, (b) number of close friends and relatives, (c) reported contact with close friends and relatives. Age standardized mortality rates (per 10,000 person years) were computed for men and women. Sex-specific Cox-proportional hazard models were used and hazard rate ratios (HRR) were calculated adjusting for age, hypertension, cigarette smoking, cholesterol, drinking alcohol, number of chronic diseases and self-reported health. Mortality rates were higher for men who were living alone (437.3) than for married men (235.3). Respectively in women the rates were 121.6 compared to 80.7. After controlling for age and self-reported health a HRR of 1.5 (95% CI: 1.0-2.4) was observed for single, divorced or widowed men and a HRR of 1.6 (95% CI: 0.8-3.0) for women living alone. Low mortality rates were observed in people with many social ties (men: 180.1, women: 29.9). Mortality rates of people who gave no informations about social ties (men: 349.5, women: 124.9) were similar to those who had only few social ties (men: 321.1, women: 132.5). The findings showed that people with few social ties were more likely to die in the follow-up period than those with more extensive contacts. After adjusting for age and self-reported health the HRR for those with few ties compared to those with many social ties were 1.6 (95% CI: 1.1-2.5) for men and 2.7 (95% CI: 1.1-6.6) for women. Similar results were found for people who gave no informations about their social ties (men: HRR = 1.4, 95% CI: 0.9-2.3; women: HRR = 2.6, 95% CI: 1.0-6.9). Social relationships were shown to be important predictors of mortality in elderly women and men. These findings confirm the need for further research, which enables to take steps against high mortality of the social isolated elderly.