Living Alone is Associated with All-Cause and Cardiovascular Mortality

32 years of follow-up in The Copenhagen Male Study

Magnus T Jensen*, Jacob L Marott, Andreas Holtermann, Finn Gyntelberg

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear.

METHODS AND RESULTS: Participants from The Copenhagen Male Study were included in 1985-86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4% of the population died and 38.9% of cardiovascular causes. Living alone (9.6%) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95% confidence interval)] 1.23 (1.09-1.39), P = 0.001 for all-cause mortality and 1.36 (1.13-1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7-1.39), P = 0.91 and 0.94 (0.6-1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16-2.19), P = 0.004 for all-cause mortality and 1.87 (1.20-2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation.

CONCLUSIONS: Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals.

Original languageEnglish
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume5
Issue number3
Pages (from-to)208-217
ISSN2058-5225
DOIs
Publication statusPublished - 1. Jul 2019

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Health Policy
Proportional Hazards Models
Causality
Registries
Confidence Intervals
Health
Population

Cite this

@article{fcd3da59da524923bb9a2387bee9f611,
title = "Living Alone is Associated with All-Cause and Cardiovascular Mortality: 32 years of follow-up in The Copenhagen Male Study",
abstract = "AIMS: As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear.METHODS AND RESULTS: Participants from The Copenhagen Male Study were included in 1985-86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4{\%} of the population died and 38.9{\%} of cardiovascular causes. Living alone (9.6{\%}) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95{\%} confidence interval)] 1.23 (1.09-1.39), P = 0.001 for all-cause mortality and 1.36 (1.13-1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7-1.39), P = 0.91 and 0.94 (0.6-1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16-2.19), P = 0.004 for all-cause mortality and 1.87 (1.20-2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation.CONCLUSIONS: Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals.",
author = "Jensen, {Magnus T} and Marott, {Jacob L} and Andreas Holtermann and Finn Gyntelberg",
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Living Alone is Associated with All-Cause and Cardiovascular Mortality : 32 years of follow-up in The Copenhagen Male Study. / Jensen, Magnus T; Marott, Jacob L; Holtermann, Andreas; Gyntelberg, Finn.

In: European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 5, No. 3, 01.07.2019, p. 208-217.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Living Alone is Associated with All-Cause and Cardiovascular Mortality

T2 - 32 years of follow-up in The Copenhagen Male Study

AU - Jensen, Magnus T

AU - Marott, Jacob L

AU - Holtermann, Andreas

AU - Gyntelberg, Finn

PY - 2019/7/1

Y1 - 2019/7/1

N2 - AIMS: As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear.METHODS AND RESULTS: Participants from The Copenhagen Male Study were included in 1985-86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4% of the population died and 38.9% of cardiovascular causes. Living alone (9.6%) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95% confidence interval)] 1.23 (1.09-1.39), P = 0.001 for all-cause mortality and 1.36 (1.13-1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7-1.39), P = 0.91 and 0.94 (0.6-1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16-2.19), P = 0.004 for all-cause mortality and 1.87 (1.20-2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation.CONCLUSIONS: Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals.

AB - AIMS: As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear.METHODS AND RESULTS: Participants from The Copenhagen Male Study were included in 1985-86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4% of the population died and 38.9% of cardiovascular causes. Living alone (9.6%) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95% confidence interval)] 1.23 (1.09-1.39), P = 0.001 for all-cause mortality and 1.36 (1.13-1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7-1.39), P = 0.91 and 0.94 (0.6-1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16-2.19), P = 0.004 for all-cause mortality and 1.87 (1.20-2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation.CONCLUSIONS: Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals.

U2 - 10.1093/ehjqcco/qcz004

DO - 10.1093/ehjqcco/qcz004

M3 - Journal article

VL - 5

SP - 208

EP - 217

JO - European Heart Journal - Quality of Care and Clinical Outcomes

JF - European Heart Journal - Quality of Care and Clinical Outcomes

SN - 2058-5225

IS - 3

ER -