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

RATIONALE: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet have not been defined in people with 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 Health and Retirement Study (HRS) (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 9-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.

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p>RESULTS: Participants (n=10,384) were on average 68 years old (SD±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 gender (men: 22%, women: 13%), non-Hispanic White ethnicity (White: 19%, Black: 7%), low net-worth ($<6000: 32%, $81,001-239,000: 10%), depression (depression: 24%, no depression: 14%), having ≥1 ADL difficulty (≥1 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 years: 22%, 75-84 years: 12%), being single (single: 32%, married: 12%), depression (depression: 36%, no depression: 13%), having ≥1 ADL difficulty (≥1 difficulty: 29%, no difficulty: 15%), diabetes (diabetes: 26%, no diabetes: 17%), and heart disease (heart disease 23%, no heart disease: 17%).

CONCLUSIONS: Nearly 1 in 6 adults with COPD experience social isolation, and 1 in 5 experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared to the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions. Primary source of funding: NIH NHLBI T32HL007185-45.