An observational analysis of frailty in combination with loneliness or social isolation and their association with socioeconomic deprivation, hospitalisation and mortality among UK Biobank participants

Politis, M., Crawford, L. , Jani, B. D. , Nicholl, B. I. , Lewsey, J. , McAllister, D. A. , Mair, F. S. and Hanlon, P. (2024) An observational analysis of frailty in combination with loneliness or social isolation and their association with socioeconomic deprivation, hospitalisation and mortality among UK Biobank participants. Scientific Reports, 14, 7258. (doi: 10.1038/s41598-024-57366-7)

Abstract

Frailty, social isolation, and loneliness have individually been associated with adverse health outcomes. This study examines how frailty in combination with loneliness or social isolation is associated with socioeconomic deprivation and with all-cause mortality and hospitalisation rate in a middle-aged and older population. Baseline data from 461,047 UK Biobank participants (aged 37–73) were used to assess frailty (frailty phenotype), social isolation, and loneliness. Weibull models assessed the association between frailty in combination with loneliness or social isolation and all-cause mortality adjusted for age/sex/smoking/alcohol/socioeconomic-status and number of long-term conditions. Negative binomial regression models assessed hospitalisation rate. Frailty prevalence was 3.38%, loneliness 4.75% and social isolation 9.04%. Frailty was present across all ages and increased with age. Loneliness and social isolation were more common in younger participants compared to older. Co-occurrence of frailty and loneliness or social isolation was most common in participants with high socioeconomic deprivation. Frailty was associated with increased mortality and hospitalisation regardless of social isolation/loneliness. Hazard ratios for mortality were 2.47 (2.27–2.69) with social isolation and 2.17 (2.05–2.29) without social isolation, 2.14 (1.92–2.38) with loneliness and 2.16 (2.05–2.27) without loneliness. Loneliness and social isolation were associated with mortality and hospitalisation in robust participants, but this was attenuated in the context of frailty. Frailty and loneliness/social isolation affect individuals across a wide age spectrum and disproportionately co-occur in areas of high deprivation. All were associated with adverse outcomes, but the association between loneliness and social isolation and adverse outcomes was attenuated in the context of frailty. Future interventions should target people living with frailty or loneliness/social isolation, regardless of age.

• Item Type: Articles
• Additional Information: This work was funded by the Medical Research Council, Grant number MR/S021949/1.
• Keywords: Frailty, Social isolation, loneliness, mortality, hospitalisation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David and Jani, Dr Bhautesh and Hanlon, Dr Peter and Lewsey, Professor Jim and Crawford, Dr Lynsay and Mair, Professor Frances and Nicholl, Dr Barbara
• Authors: Politis, M., Crawford, L., Jani, B. D., Nicholl, B. I., Lewsey, J., McAllister, D. A., Mair, F. S., and Hanlon, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Scientific Reports
• Publisher: Nature Research
• ISSN: 2045-2322
• ISSN (Online): 2045-2322
• Copyright Holders: Copyright: © The Author(s) 2024
• First Published: First published in Scientific Reports 14: 7258
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
305232		Understanding prevalence and impact of frailty in chronic illness and implications for clinical management	Frances Mair	Medical Research Council (MRC)	MR/S021949/1	SHW - General Practice & Primary Care