Associations between Living Alone and Smoking and Alcohol Consumption in Korean Adults

The influencing factors of health status among low-income individuals living alone in Wuxi, China

This study aimed to understand the health status of low-income individuals living alone and to identify influencing factors. Using systematic random sampling methods, low-income individuals living alone were randomly selected. Via telephone interviews, we gathered information about their general health status. A logistic regression model was used to analyze relevant factors about the physical health of this population. The study included 1583 low-income individuals living alone. The prevalence rate of all kinds of diseases in low-income living alone in this survey was 88.63%. The multifactorial logistic regression analysis revealed that the risk factors for illness in this population were age ≥ 60 (OR 1.842, 95% CI 1.135-2.926, P = 0.006), self-rated poor mental health (OR 2.538, 95% CI 1.128-3.828, P = 0.005), and self-rated poor hearing status (OR 2.781, 95% CI 1.586-3.647, P = 0.001). Being female (OR 0.469, 95% CI 0.178-0.821, P = 0.033) was identified as a protective factor. Low-income individuals living alone are a unique group who lack familial care and economic and social support, and are thus in a disadvantaged social position. Therefore, this population requires increased attention, especially regarding their physical health. Implementing targeted assistance policies to improve their health status and enhance their quality of life is essential.

Smaller household size and higher prevalence of serious psychological distress in younger people and never-married people: a nationwide cross-sectional survey in Japan

Background

Small-member households are increasing worldwide. However, most previous studies have focused on older people and living alone. Using the latest national survey data, we investigated a dose-response relationship between household size and serious psychological distress (SPD).

Methods

We analyzed data from the 2019 Comprehensive Survey of Living Conditions in Japan. The study participants were 405,560 community-dwelling adults aged 20 or older. Household size was classified into 5 or more, 3 or 4, two, and one (i.e., living alone). SPD was defined as ≥13 points based on the Kessler 6-item Psychological Distress Scale. We used multivariable logistic regressions and included age, education, equivalent household expenditures, housing tenure, employment contract, smoking, and illness under treatment as covariates.

Results

After stratified analyses by age and gender, a dose-response relationship between smaller household size and more common SPD was significant for younger, but not for older people (p-trend was <0.001 in men aged 20-59 and women aged 20-39). After stratified analyses by gender and marital status, a dose-response relationship was significant only for the never-married group in both genders (p-trend was <0.001 in never-married men and women).

Conclusion

Smaller households were associated with higher prevalence of SPD in younger adults and in never-married individuals, regardless of gender. Our findings suggest a need to focus on younger people and never-married people to reduce the mental health risks due to small household sizes.

Association between living alone and all-cause mortality of young and middle-aged patients with acute myocardial infarction: analysis of the China Acute Myocardial Infarction (CAMI) registry

BACKGROUND

Lack of social support is a known predictor of the prognosis after acute myocardial infarction (AMI). Although as a common factor associated with social support, there are limited data on long-term prognostic impact of living status in young and middle-aged patients with AMI.

METHODS

We analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, consecutive AMI young and middle-aged patients admitted at 108 hospitals in China between January 2013 and September 2014 were included. Eligible patients were assigned to living alone and not living alone groups based on their living status. The primary endpoint was 2-year all-cause mortality. The secondary endpoints included in-hospital mortality and 2-year major adverse cardiac and cerebrovascular events (MACCEs; a composite of all-cause mortality, MI, or stroke). Multilevel logistic and multilevel Cox regression models were used to evaluate the effect of living status on short-term and long-term outcomes.

RESULTS

A total of 8307 consecutive AMI young and middle-aged patients were included, 192 (2.3%) patients were living alone. Of the analyzed patients, living alone was associated with 2-year all-cause mortality and MACCEs among all analyzed patients after multivariate adjustment (adjusted hazard ratio [HR] = 2.171 [1.210-3.895], P = 0.009; adjusted HR = 2.169 [1.395-3.370], P = 0.001), but not with poorer in-hospital mortality.

CONCLUSIONS

The analysis suggested that living alone was associated with both 2-year all-cause mortality and MACCEs in AMI young and middle-aged patients but did not show an extra effect on the in-hospital mortality after covariate adjustment.

TRIAL REGISTRATION

Trial registration number: NCT01874691; Registered 31 October 2012.

Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working-age adults

BACKGROUND

Previous studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined.

METHODS

Pooled 1998-2019 data for adults aged 18-64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow-up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality.

RESULTS

Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age-adjusted model (HR, 1.32; 95% CI, 1.25-1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04-1.16). Age-adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non-Hispanic White adults (HR, 1.33; 95% CI, 1.25-1.42) than non-Hispanic Black adults (HR, 1.18; 95% CI, 1.05-1.32; p value for difference < .05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05-1.23), women (HR, 1.09; 95% CI, 1.01-1.18), non-Hispanic White adults (HR, 1.13; 95% CI, 1.05-1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07-1.39).

CONCLUSIONS

In this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups.

Six-year mortality associated with living alone and loneliness in Swedish men and women born in 1930

BACKGROUND

This study examined how living alone and loneliness associate with all-cause mortality in older men and women.

METHODS

Baseline data from the Gothenburg H70 Birth Cohort Studies, including 70-year-olds interviewed in 2000 and 75-year-olds (new recruits) interviewed in 2005 were used for analyses (N = 778, 353 men, 425 women). Six-year mortality was based on national register data.

RESULTS

At baseline, 36.6% lived alone and 31.9% reported feelings of loneliness. A total of 72 (9.3%) participants died during the 6-year follow-up period. Cumulative mortality rates per 1000 person-years were 23.9 for men and 9.6 for women. Mortality was increased more than twofold among men who lived alone compared to men living with someone (HR 2.40, 95% CI 1.34-4.30). Elevated risk remained after multivariable adjustment including loneliness and depression (HR 2.56, 95% CI 1.27-5.16). Stratification revealed that mortality risk in the group of men who lived alone and felt lonely was twice that of their peers who lived with someone and did not experience loneliness (HR 2.52, 95% CI 1.26-5.05). In women, a more than fourfold increased risk of mortality was observed in those who experienced loneliness despite living with others (HR 4.52, 95% CI 1.43-14.23).

CONCLUSIONS

Living alone was an independent risk factor for death in men but not in women. Mortality was doubled in men who lived alone and felt lonely. In contrast, mortality was particularly elevated in women who felt lonely despite living with others. In the multivariable adjusted models these associations were attenuated and were no longer significant after adjusting for mainly depression in men and physical inactivity in women. Gender needs to be taken into account when considering the health consequences of living situation and loneliness.

[Determinants of Problem Drinking by Regional Variation among Adult Males in Single-Person Households: Geographically Weighted Regression Model Analysis]

PURPOSE

This study aimed to identify regional differences in problem drinking among adult males in single-person households and predict the determinants.

METHODS

This study used data from the 2019 Community Health Survey. Geographically weighted regression analysis was performed on 8,625 adult males in single-person households who had been consuming alcohol for the past year. The Si-Gun-Gu was selected as the spatial unit.

RESULTS

The top 10 regions for problem drinking among adult males in single-person households were located in the Jeju-do and Jeollanam-do areas near the southern coast, whereas the bottom 10 regions were located in the Incheon and northern Gyeonggi-do areas. Smoking, economic activity, and educational level were common factors affecting problem drinking among this population. Among the determinants of regional disparities in problem drinking among adult males in single-person households, personal factors included age, smoking, depression level, economic activity, educational level, and leisure activity, while regional factors included population and karaoke venue ratio.

CONCLUSION

Problem drinking among adult males in single-person households varies by region, and the variables affecting each particular area differ. Therefore, it is necessary to develop interventions tailored to individuals and regions that reflect the characteristics of each region by prioritizing smoking, economic activity, and educational level as the common factors.

Living alone and all-cause mortality in community-dwelling adults: A systematic review and meta-analysis

Background

The non-causal and causal associations, possible age and sex differences between living alone and all-cause mortality among adults were unclear. We aimed to assess the association and causal relation between living alone and all-cause mortality among community-dwelling adults, addressing the certainty of evidence, possible age and sex differences.

Methods

We searched Medline, Embase, and APA PsycINFO for cohort studies examining the association between living alone and all-cause mortality on November 19, 2021. We used the GRADE approach to assess certainty of evidence, and the Instrument for the Credibility of Effect Modification Analyses (ICEMAN) to evaluate credibility of subgroup inferences and conducted a meta-analysis of measures of association between living alone and mortality. The study was registered with PROSPERO, CRD42021290895.

Findings

18 cohort studies with 62,174 adults proved eligible. Living alone was associated with mortality (relative risk (RR) = 1.15, 95% confidence interval (CI) 1.08-1.23). Both age and sex modified the association (high and moderate credibility, separately). Living alone increased the risk of dying only in younger but not older individuals (ratio of RRs = 1.59, interaction P = 0.003; younger RR 1.41, 95% CI 1.17-1.71, high certainty for prognosis, low for causation; older RR = 1.05, 95% CI 0.91-1.22, moderate certainty for prognosis, very low for causation). Living alone increased risk to a greater extent in males than females (ratio of RRs = 1.39, 95% CI 1.14-1.70; interaction P = 0.001, males RR = 1.41, 95% CI 1.17-1.71, high certainty for prognosis, low for causation; females RR = 1.15, 95% CI 0.99-1.33; moderate for prognosis factor, very low for causation).

Interpretation

Living alone is associated with increased mortality in individuals under 65 years (high certainty) but not with those over 75 years; the association may be causal (low certainty). Associations, and possibly effects, may be stronger in men than women.

Funding

None.

Living Alone Is Not Associated With Cardiovascular Events and Hypoglycemia in Patients With Type 2 Diabetes Mellitus

Objective:

Living alone is often associated with reduced social support. However, there are limited data on the relationship between living alone and cardiovascular events or hypoglycemia in patients with type 2 diabetes mellitus (T2DM). This study reports a post-hoc analysis of the “Action to Control Cardiovascular Risk in Diabetes (ACCORD)” study.

Research Design and Methods

The Cox proportional hazard models were used to compare the hazard ratios (HRs) for the adverse health events selected as primary endpoints in the study participants; these were compared between those living alone and those living with others. The primary outcomes were hypoglycemia requiring any assistance (HAA), hypoglycemia requiring medical assistance (HMA), and major cardiovascular events (MACEs, including cardiac death, non-fatal myocardial infarction (MI), and non-fatal stroke). Our study included 10,249 participants (2,078 living alone) with a follow-up period of 4.91 ± 1.22 years.

Results

After a multivariable adjustment, the risk of HAA, HMA, and MACEs did not differ significantly between participants living alone and those living with others (HAA, HR: 0.88, 95% CI: 0.75–1.04, P = 0.13; HMA, HR: 1.11, 95% CI: 0.92–1.34, P = 0.26; MACEs, HR: 0.98, 95% CI: 0.80–1.19, P = 0.82). Participants living alone had higher levels of glycated hemoglobin in the middle follow-up period than those living with others.

Conclusions

In patients with T2DM, living alone did not increase the risk of cardiovascular events (cardiac death, non-fatal MI, or non-fatal stroke) and hypoglycemia. Patients living alone had higher Hb1AC levels than those living with others. Clinicians should consider an effective blood glucose control regardless of their living arrangement.

Association between Increasing Social Capital and Decreasing Prevalence of Smoking at the Municipality Level: Repeated Cross-Sectional Study from the JAGES

As smoking cessation is crucial for both individual and public health, this study aimed to elucidate the association between changes in social capital and in terms of smoking at the level of municipal units in Japan. Using repeated cross-sectional data from the Japan Gerontological Evaluation Study, we analyzed data from adults aged 65 years or older from 69 municipal units that participated in two survey waves. We received valid responses from 91,529 and 86,403 older people in 2013 and 2019, respectively, and aggregated all variables by municipal units. For the dependent variable, we used the units’ prevalence of smoking for both years. The independent variables were the percentages of social capital indicators, such as social participation, social cohesion, and reciprocity for each of the 69 municipal units. The mean prevalence of smoking increased from 9.7% in 2013 to 10.2% in 2019. Multiple regression analysis revealed that increases in the percentages of sports group participation, receiving emotional and instrumental social support, and reciprocity were significantly associated with decreased prevalence of smoking, after we adjusted for confounding variables. This study indicates that building social capital might be useful in promoting smoking cessation and that its indicators could be useful in monitoring efforts.