Living Alone and Risk of Mortality in Older, Community-Dwelling Adults
Is living alone associated with an increased risk for death?
Data from the Blue Mountains Eye Study were used for the present analysis. This study is a population-based cohort, which enrolled 3,654 participants, 49 years or older, from 1992 to 1994. At the 5-year follow-up examination, 2,335 surviving participants (75.1% of survivors; 543 had died) and an additional 1,174 individuals were examined, providing a sample of 3,486 individuals with self-reported health status information, and without missing data on mortality or information on living alone. Health status was assessed through the Short Form (SF)-36. Participants were classified as living alone through self-report. The primary outcome of interest was all-cause mortality, assessed through the Australian National Death Index for deaths until December 31, 2007 (10-year follow-up). Cause-specific death was assessed through International Classification of Diseases (ICD)-9 and ICD-10 codes.
A total of 3,486 participants were included in this analysis. During the 10-year follow-up period, 739 participants (21.2%) died. After adjustment for age, sex, educational status, current smoking, body mass index, walking disability, prior diagnosis of heart disease, angina, heart attack, diabetes mellitus, cancer, poor self-rated health, and SF-36 mental and physical component summary scores, living alone was not associated with total mortality in the overall cohort (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.98-1.43). Among participants younger than 75 years, living alone was associated with a 36% increased risk of all-cause mortality (15.0% vs. 11.4%; multivariate-adjusted HR, 1.36 [95% CI, 1.04-1.79]). Among those 75 years or older, living alone was not associated with both total mortality (HR, 1.08; 95% CI, 0.83-1.41) and cardiovascular disease mortality (p = 0.48).
The investigators concluded that among a population-based cohort of community-dwelling adults, living alone was a significant predictor of all-cause mortality among adults under the age of 75 years.
The study provides information which supports prior findings suggesting that living alone may identify individuals who are at increased risk for death; however, the risk appears to be for younger adults. As the accompanying editorial suggests, perhaps those over age 75 who are able to live alone have improved functional status compared to those residing with others. Since functional status is an important predictor of mortality, understanding how functional status influences our living environment is critical.
Keywords: Cause of Death, International Classification of Diseases, Australia
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