Elsevier

Annals of Epidemiology

Volume 21, Issue 1, January 2011, Pages 26-33
Annals of Epidemiology

Social Connections, Diabetes Mellitus, and Risk of Mortality among White and African-American Adults Aged 70 and Older: An Eight-Year Follow-up Study

https://doi.org/10.1016/j.annepidem.2010.10.012Get rights and content

Purpose

To examine the independent and joint effects of having a lack of social connections (LSC) and diabetes mellitus (DM) on the risk of mortality among older white and African-American (AA) adults.

Methods

Data (N = 9246) from the Second Longitudinal Study of Aging was used. LSC score was created by the use of seven social connection measures. Subjects with a score ≥90% of the distribution in the total sample were classified having LSC.

Results

Subjects with LSC, DM, or both had significantly greater risks of death. After multiple covariates were adjusted, the hazard ratios (95% confidence interval) of death in those with both LSC and DM were 2.45 (2.43–2.47) in white men, and 2.95 (2.91–2.99) in AA men. The corresponding values were 2.72 (2.70–2.73) in white women and 3.13 (3.09–3.18) in AA women. Those who had LSC but had no DM, had a similar survival trend to those who had DM only.

Conclusions

The risk of LSC for mortality is similar to DM. Both factors are independent predictors of death among white and AA adults. In addition to controlling disease risks, improvement of social connections may offer new insights to the reduction of mortality among older adults.

Introduction

Diabetes mellitus (DM) is the seventh-leading cause of death in the United States. According to the reports by the Centers for Disease Control and Prevention, DM contributed to a total of 233,619 deaths in 2005 in this country 1, 2. Furthermore, the incidence, prevalence, and mortality caused by diabetes and diabetic complications (cardiovascular diseases in particular), increase with aging 2, 3, 4, 5, 6. In addition to mortality risk from diseases, social factors may also have important effects on the risk of mortality 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Of social factors, social connections, including social communications with family and friends and participation in neighborhood activities, may be especially important during old age when individuals face the greatest risk of illness and disruption in their sources of support 8, 17. However, it is unknown whether a lack of social connections has a significant effect on the risk of death after adjustment for disease and other covariates. Also, the degree to which an excessive risk of death caused by a combined effect of being poor social connections and disease has not been well studied. We hypothesized that both social connections and DM are independent predictors of death and that subjects exposed to both risk factors are at a greater risk of death. To test these hypotheses, we used data from the national Second Longitudinal Study of Aging (LSOA II) (18).

Section snippets

Study Design and Participants

The LSOA II study design and sample selection procedures have been documented and published elsewhere (18). In brief, the LSOA II is a collaborative effort between the National Center for Health Statistics (NCHS) and the National Institute on Aging. The goals of the LSOA II study are to better understand disability pathways and interrelationships between determinants and functional outcomes among older adults. The LSOA II is a longitudinal study with a nationally representative sample

Characteristics of Participants

Table 1 shows that 25.1% of African-American (AA) and 22.1% of white men were aged 80 and older (p < .001). AA men had significantly greater smoking rates than white men (32.9% vs. 20.0%, p<0.001), and they had significantly lower prevalence of coronary heart disease than White males (19.5% vs. 25.5%, p = .024). However, AA men had a significantly greater prevalence of hypertension (48.7% vs. 38.2%, p < .05), and diabetes (21.3% vs. 12.1%, p < .001) than white men.

In women, 26.7% of AA and

Discussion

The present study demonstrates significant associations of having LSC or DM with an increased risk of death among older American adults. Subjects with both LSC and DM had significant combined effects on the risk of death. Furthermore, LSC alone showed to have a similar impact on the survival trends compared with those who had DM only. These associations of LSC and DM with risk of mortality remained significant after adjusting for multiple covariates.

The association between DM and risk of

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