Social Integration, Social Support, and All-Cause, Cardiovascular Disease and Cause-Specific Mortality: A Prospective...

Social relationships are associated with all-cause mortality. Substantial uncertainties remain, however, for the associations of social relationships with mortality from subtypes of cardiovascular disease (CVD) and major non-vascular diseases. This prospective cohort study estimated mortality risks according to social support and social integration utilizing a nationally representative sample of 29,179 adults ages 18 years and older. Cox proportional hazards regression models were employed. Social integration, but not social support was associated with all-cause mortality risk. For CVD mortality, social integration predicted a 33% lower risk (HR = 0.67, 95% CI = 0.53-0.86). The results were similar in magnitude for heart disease mortality. Participants with the highest social integration level had a 53%, 30%, and 47% decreased mortality risk of diabetes, Alzheimer's disease, and chronic lower respiratory diseases (CLRD) than those with the lowest level. These social integration associations were linear and consistent across baseline age, sex and socioeconomic status. We did not observe an association of social integration with the risk of cancer mortality. Our findings support the linear association of social integration but not social support with mortality from a range of major chronic diseases in the US adult population, independent of socioeconomic status (SES), behavioral risk factors, and health status.