Study Links Living Alone to Respiratory Disease Hospitalization Risk

Daisy Fancourt, PhD

Living alone and being socially disengaged are risk factors for respiratory disease, according to new research on links between social factors and health conditions in older adults.

The study, published in the journal Thorax, focused on modifiable risk factors among 4,478 patients who were part of the English Longitudinal Study on Aging. Investigators matched registry data with hospital records and mortality registry data, and found that living alone and being socially disconnected were associated with an increased risk of respiratory disease (RD). However, other social factors, such as loneliness and level of social contact, were not.

The patients in the study were tracked until the year 2018, unless they died prior to the end of the study. The average follow-up period was 9.6 years.

Lead author Daisy Fancourt, PhD, of University College London, told Contagion that the latest study is part of a broader inquiry into links between isolation and various health conditions.

“Our findings for RD echoed previous findings from our studies suggesting that isolation is a risk factor for requiring hospital care,” she said, “but the results were more nuanced, showing that it is specifically living alone and disengaging from social and community activities that are risk factors.”

Altogether, 11% of the patients in the study were admitted to the hospital for RD. However, people living alone had a 32% risk of being hospitalized for RD; and people who reported poor social engagement had a risk of 24%.

Fancourt and colleagues suggest a number of possible reasons why these groups of people would be at a higher risk. One possibility is that people who are socially disconnected have higher rates of being physically inactive or smoking. Another reason could be that someone living alone might not have the same social pressure to visit a doctor if they show symptoms of illness.

The causative factor could also be on the side of clinicians, Fancourt suggested, since some physicians might be more likely to admit a patient to the hospital if they live alone and are at risk of being injured from a fall.

Fancourt said the findings of her study should be one factor doctors use alongside other biological and behavioral risk factors for RD. She said physicians should consider social-prescribing for these patients--connecting them to social activities within the community.

Such programs have become common in many countries, and are part of the United Kingdom’s national program, she added.

Though the study was conducted prior to the outbreak of coronavirus disease 2019 (COVID-19), it also raises interesting questions for physicians and public health officials who are now treating patients with the illness. Ironically, the pandemic has meant an increase both in terms of hospitalizations for respiratory disease, and in terms of the risk factors Fancourt and colleagues identified (social isolation).

Given the differences between COVID-19 and the diseases referenced in her study, Fancourt said it’s not possible to generalize her study’s findings to make direct insights about the new pandemic.

“But the results feed into results from other studies suggesting that social support for individuals who live alone who contract viruses or infections is valuable,” she said.