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      Association of loneliness with all-cause mortality: A meta-analysis

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          Abstract

          Introduction

          Loneliness has social and health implications. The aim of this article is to evaluate the association of loneliness with all-cause mortality.

          Methods

          Pubmed, PsycINFO, CINAHL and Scopus databases were searched through June 2016 for published articles that measured loneliness and mortality. The main characteristics and the effect size values of each article were extracted. Moreover, an evaluation of the quality of the articles included was also carried out. A meta-analysis was performed firstly with all the included articles and secondly separating by gender, using a random effects model.

          Results

          A total of 35 articles involving 77220 participants were included in the systematic review. Loneliness is a risk factor for all-cause mortality [pooled HR = 1.22, 95% CI = (1.10, 1.35), p < 0.001] for both genders together, and for women [pooled HR = 1.26, 95% CI = (1.07, 1.48); p = 0.005] and men [pooled HR = 1.44; 95% CI = (1.19, 1.76); p < 0.001] separately.

          Conclusions

          Loneliness shows a harmful effect for all-cause mortality and this effect is slightly stronger in men than in women. Moreover, the impact of loneliness was independent from the quality evaluation of each article and the effect of depression.

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          Most cited references 80

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          Measuring inconsistency in meta-analyses.

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            Bias in meta-analysis detected by a simple, graphical test.

            Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews. Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution.
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              A Coefficient of Agreement for Nominal Scales

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                Author and article information

                Affiliations
                [1 ] Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
                [2 ] Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
                [3 ] Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
                Jerusalem Institute of Aging Research, ISRAEL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Contributors
                Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Investigation, Role: Methodology, Role: Writing – original draft, Role: Writing – review & editing
                Role: Data curation, Role: Formal analysis, Role: Methodology, Role: Validation, Role: Writing – review & editing
                Role: Data curation, Role: Investigation, Role: Methodology, Role: Writing – review & editing
                Role: Data curation, Role: Investigation, Role: Writing – review & editing
                Role: Conceptualization, Role: Funding acquisition, Role: Project administration, Role: Supervision, Role: Writing – review & editing
                ORCID: http://orcid.org/0000-0003-3252-854X, Role: Conceptualization, Role: Project administration, Role: Supervision, Role: Validation, Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 January 2018
                2018
                : 13
                : 1
                PONE-D-16-49272
                10.1371/journal.pone.0190033
                5754055
                29300743
                © 2018 Rico-Uribe et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Figures: 5, Tables: 3, Pages: 21
                Product
                Funding
                Funded by: European Commission Horizon 2020 (ATHLOS)
                Award ID: 635316
                Funded by: Instituto de Salud Carlos III-FIS
                Award ID: PI13/00059
                Award Recipient :
                Funded by: European Union European Regional Development Fund (ERDF) “A Way to Build Europe”
                Award ID: PI13/00059
                Funded by: "Contratos predoctorales para Formación de Personal Investigador, FPI-UAM", Universidad Autónoma de Madrid, Spain
                Award Recipient :
                Funded by: "Contratos predoctorales para Formación de Personal Investigador, FPI-UAM", Universidad Autónoma de Madrid, Spain
                Award Recipient :
                Funded by: Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
                The research leading to these results has received funding from the European Commission Horizon 2020 under the project Ageing Trajectories of Health: Longitudinal Opportunities and Synergies with the grant number 635316 ( http://athlosproject.eu), and from the Instituto de Salud Carlos III-FIS research grant number PI13/00059 ( http://edadconsalud.com). The project PI13/00059 has been co-funded by the European Union European Regional Development Fund (ERDF) “A Way to Build Europe”. Laura Rico and Natalia Martín-María are supported by the program "Contratos predoctorales para Formación de Personal Investigador, FPI-UAM", Universidad Autónoma de Madrid, Spain ( https://www.uam.es/ss/Satellite/es/1242648594098/1242695570937/becainvestigacion/becaInvestig/Convocatoria_de_Contratos_Predoctorales_para_Formacion_de_Personal_Investigador_2016_(FPI-UAM.htm). The work was supported by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III ( http://www.cibersam.es). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Meta-Analysis
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Statistical Methods
                Meta-Analysis
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Research and Analysis Methods
                Research Assessment
                Systematic Reviews
                Research and Analysis Methods
                Database and Informatics Methods
                Database Searching
                Science Policy
                Research Integrity
                Publication Ethics
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Geriatric Depression
                Medicine and Health Sciences
                Geriatrics
                Geriatric Psychiatry
                Geriatric Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Geriatric Psychiatry
                Geriatric Depression
                People and places
                Geographical locations
                Europe
                European Union
                Germany
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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