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A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality

Nature Human Behaviour volume 7, pages 1307–1319 (2023)Cite this article

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Abstract

The associations between social isolation, loneliness and the risk of mortality from all causes, cardiovascular disease (CVD) and cancer are controversial. We systematically reviewed prospective studies on the association between social isolation, loneliness and mortality outcomes in adults aged 18 years or older, as well as studies on these relationships in individuals with CVD or cancer, and conducted a meta-analysis. The study protocol was registered with PROSPERO (reg. no. CRD42022299959). A total of 90 prospective cohort studies including 2,205,199 individuals were included. Here we show that, in the general population, both social isolation and loneliness were significantly associated with an increased risk of all-cause mortality (pooled effect size for social isolation, 1.32; 95% confidence interval (CI), 1.26 to 1.39; P < 0.001; pooled effect size for loneliness, 1.14; 95% CI, 1.08 to 1.20; P < 0.001) and cancer mortality (pooled effect size for social isolation, 1.24; 95% CI, 1.19 to 1.28; P < 0.001; pooled effect size for loneliness, 1.09; 95% CI, 1.01 to 1.17; P = 0.030). Social isolation also increased the risk of CVD mortality (1.34; 95% CI, 1.25 to 1.44; P < 0.001). There was an increased risk of all-cause mortality in socially isolated individuals with CVD (1.28; 95% CI, 1.10 to 1.48; P = 0.001) or breast cancer (1.51; 95% CI, 1.34 to 1.70; P < 0.001), and individuals with breast cancer had a higher cancer-specific mortality owing to social isolation (1.33; 95% CI, 1.02 to 1.75; P = 0.038). Greater focus on social isolation and loneliness may help improve people’s well-being and mortality risk.

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Fig. 1: Studies included in the present review.
Fig. 2: Association of SI or loneliness and risk of all-cause mortality.
Fig. 3: Association of SI or loneliness and risk of cardiovascular or circulatory system disease mortality.
Fig. 4: Association of SI or loneliness and risk of cancer mortality.

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Data availability

All included literature is available in PubMed (https://pubmed.ncbi.nlm.nih.gov/), Web of Science (https://www.webofscience.com) and Embase (https://www.embase.com). The data that support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

This work was supported by the Dr. Wu Lien teh Science Foundation of Harbin Medical University (WLD-QN1106, F.W.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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  1. These authors contributed equally: Fan Wang, Yu Gao.

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China

    Fan Wang, Yu Gao, Zhen Han, Yue Yu, Zhiping Long, Yi Wu, Bing Pei, Yukun Cao, Jingyu Ye & Yashuang Zhao

  2. NHC Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, P. R. China

    Fan Wang & Yashuang Zhao

  3. Department of Chronic Disease Prevention and Control, Quzhou Center for Disease Control and Prevention, Quzhou, P. R. China

    Xianchen Jiang

  4. National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, P. R. China

    Maoqing Wang

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Contributions

F.W. and M.W. conceived the idea for the review. M.W. and F.W. designed, supervised and coordinated the study. Y.Z. gave crucial intellectual input. Y.G., Z.H. and Y.Y. searched the literature, extracted the data and assessed the risk of bias. Z.L., B.P., Y.C., Y.W., J.Y. and Y.G. coded the statistical analysis, figures and supplementary information in collaboration with X.J. Y.G., F.W. and M.W. interpreted the data. Y.G. and F.W. drafted the manuscript. F.W. obtained the funding. All authors have read and approved the final manuscript. The corresponding authors attest that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted. F.W. and M.W. are the guarantors of this manuscript.

Corresponding authors

Correspondence to Maoqing Wang or Yashuang Zhao.

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Nature Human Behaviour thanks Chen Mao, Bin Yu and Natalia Martín-María for their contribution to the peer review of this work. Peer reviewer reports are available.

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Supplementary Figs. 1–8, Tables 1–16 and Methods.

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Wang, F., Gao, Y., Han, Z. et al. A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav 7, 1307–1319 (2023). https://doi.org/10.1038/s41562-023-01617-6

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