Social connections, diabetes mellitus, and risk of mortality among white and African-American adults aged 70 and older: an eight-year follow-up study.

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.

[1]  L. Berkman,et al.  Social integration and concentrations of C-reactive protein among US adults. , 2006, Annals of epidemiology.

[2]  U Steinbach,et al.  Social networks, institutionalization, and mortality among elderly people in the United States. , 1992, Journal of gerontology.

[3]  L. Berkman,et al.  Emotional Support and Survival after Myocardial Infarction , 1992, Annals of Internal Medicine.

[4]  Daniel L. McGee,et al.  Diabetes and cardiovascular disease. The Framingham study. , 1979, JAMA.

[5]  E. Ford,et al.  The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging , 2006, BMC geriatrics.

[6]  R. D'Agostino Propensity Scores in Cardiovascular Research , 2007, Circulation.

[7]  L. Berkman,et al.  Relation of social integration to inflammatory marker concentrations in men and women 70 to 79 years. , 2006, The American journal of cardiology.

[8]  A. Hedley,et al.  Fibrinogen, other cardiovascular risk factors and diabetes mellitus in Hong Kong: a community with high prevalence of Type 2 diabetes mellitus and impaired glucose tolerance , 2000, Diabetic medicine : a journal of the British Diabetic Association.

[9]  Rick Chappell,et al.  Self-reported health and survival in the Longitudinal Study of Aging, 1984-1986. , 1995, Journal of clinical epidemiology.

[10]  B. Howard,et al.  Diabetes and cardiovascular disease , 2000, Annual review of medicine.

[11]  M. Szklo,et al.  Dietary pattern, the metabolic syndrome, and left ventricular mass and systolic function: the Multi-Ethnic Study of Atherosclerosis. , 2009, The American journal of clinical nutrition.

[12]  Ellen Meara,et al.  Use of health services by previously uninsured Medicare beneficiaries. , 2007, The New England journal of medicine.

[13]  Longjian Liu,et al.  Bundle branch block and other cardiovascular disease risk factors: US-Japan comparison. , 2010, International journal of cardiology.

[14]  S. Reis,et al.  Social Networks and Incident Stroke Among Women With Suspected Myocardial Ischemia , 2008, Psychosomatic medicine.

[15]  Longjian Liu,et al.  Taurine as the nutritional factor for the longevity of the Japanese revealed by a world-wide epidemiological survey. , 2009, Advances in experimental medicine and biology.

[16]  Garrett Fitzmaurice,et al.  Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men. , 2002, American journal of epidemiology.

[17]  Longjian Liu,et al.  Resting heart rate in relation to blood pressure: results from the World Health Organization-Cardiovascular Disease and Alimentary Comparison study. , 2010, International journal of cardiology.

[18]  P. Ridker Inflammatory biomarkers and risks of myocardial infarction, stroke, diabetes, and total mortality: implications for longevity. , 2007, Nutrition reviews.

[19]  C. Newgard,et al.  Advanced statistics: the propensity score--a method for estimating treatment effect in observational research. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[20]  B. Garvin,et al.  Social Support, Self-efficacy, and Outcome Expectations , 2006, The Diabetes educator.

[21]  Alex H. S. Harris,et al.  Volunteering is Associated with Delayed Mortality in Older People: Analysis of the Longitudinal Study of Aging , 2005, Journal of health psychology.

[22]  M. Szklo,et al.  Epidemiology: Beyond the Basics , 1999 .

[23]  A. Kreger National Death Index , 1979, Definitions.

[24]  Longjian Liu,et al.  Relationship between Social Demographic Factors and Survival within One Year of Hospital Discharge in a Cohort of Elderly Male Patients , 2003, Journal of epidemiology.

[25]  B. Tabachnick,et al.  Using Multivariate Statistics , 1983 .

[26]  R. D'Agostino Adjustment Methods: Propensity Score Methods for Bias Reduction in the Comparison of a Treatment to a Non‐Randomized Control Group , 2005 .

[27]  Susan L. Norris,et al.  Social Support and Mortality Among Older Persons With Diabetes , 2007, The Diabetes educator.

[28]  D. Rubin,et al.  Reducing Bias in Observational Studies Using Subclassification on the Propensity Score , 1984 .

[29]  P. Roberson,et al.  Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  Longjian Liu Changes in cardiovascular hospitalization and comorbidity of heart failure in the United States: findings from the National Hospital Discharge Surveys 1980-2006. , 2011, International journal of cardiology.

[31]  R. Sacco,et al.  Infectious Burden and Carotid Plaque Thickness: The Northern Manhattan Study , 2010, Stroke.

[32]  A. Karter,et al.  Race/Ethnicity, Social Support, and Associations With Diabetes Self-Care and Clinical Outcomes in NHANES , 2010, The Diabetes educator.

[33]  D. Dunlop,et al.  Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. , 2002, Archives of physical medicine and rehabilitation.

[34]  R. Sacco,et al.  Infectious burden and risk of stroke: the northern Manhattan study. , 2010, Archives of neurology.

[35]  W. Sribney,et al.  Social cohesion, social support, and health among Latinos in the United States. , 2007, Social science & medicine.

[36]  L. Berkman,et al.  Population based study of social and productive activities as predictors of survival among elderly Americans , 1999, BMJ.

[37]  S. Yusuf,et al.  Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects. , 2006, International journal of epidemiology.

[38]  R. D'Agostino,et al.  Social networks and inflammatory markers in the Framingham Heart Study. , 2006, Journal of biosocial science.

[39]  M. Titler,et al.  Estimating Effects of Nursing Intervention via Propensity Score Analysis , 2008, Nursing research.

[40]  M. Marmot,et al.  Negative aspects of close relationships and heart disease. , 2007, Archives of internal medicine.

[41]  Fernando Costa,et al.  Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. , 2005, Circulation.

[42]  N. Wareham,et al.  Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) , 2001, BMJ : British Medical Journal.

[43]  Longjian Liu,et al.  Changes in Stroke Mortality Rates for 1950 to 1997: A Great Slowdown of Decline Trend in Japan , 2001, Stroke.

[44]  Longjian Liu,et al.  Male cardiovascular mortality and dietary markers in 25 population samples of 16 countries , 2006, Journal of hypertension.

[45]  Peter Libby,et al.  Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. , 2002, JAMA.