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Social Asymmetry and Risk of Morbidity and Mortality
Pei Qin1, Eileen K Graham2, Anthony D Ong3
1Department of Behavioral Science and Health, University College London, London, United Kingdom.
JAMA Network Open
|February 11, 2026
Summary
Social asymmetry, the gap between perceived loneliness and actual social connections, increases risks for cardiovascular disease and mortality. Understanding this discrepancy is crucial for identifying individuals vulnerable to adverse health outcomes.
Area of Science:
- Gerontology and Public Health
- Social Epidemiology
- Cardiovascular Disease Research
Background:
- Social asymmetry, defined as the difference between subjective loneliness and objective social connections, is poorly understood.
- Both loneliness and social isolation are independently linked to increased morbidity and premature mortality.
- The combined impact of loneliness and social isolation on health outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between social asymmetry and the risk of developing new diseases (morbidity) and death (mortality).
- To analyze social asymmetry within a large, national cohort of older adults.
- To determine if the discrepancy between felt loneliness and social connections predicts adverse health events.
Main Methods:
- A prospective cohort study utilizing data from the English Longitudinal Study of Aging (ELSA) wave 4 (2008-2009).
- Participants aged 50 years and older in England were included.
- Social asymmetry was calculated by regressing loneliness scores on social isolation scores; outcomes included incident cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), dementia, and all-cause mortality, tracked via linked health records up to 2024.
Main Results:
- Higher social asymmetry was significantly associated with an increased risk of developing CVD (HR, 1.06) and all-cause mortality (HR, 1.04).
- Individuals categorized as 'socially vulnerable' (high loneliness, low isolation) exhibited higher risks for mortality, CVD, and COPD compared to the 'socially resilient'.
- The 'concordant high lonely' group (high loneliness, high isolation) showed increased risks for all investigated health outcomes, while the 'discordant susceptible' group (high loneliness, low isolation) faced elevated risks for CVD and mortality.
Conclusions:
- This study highlights that social asymmetry is a significant predictor of incident morbidity and mortality in older adults.
- The findings underscore the importance of assessing both subjective loneliness and objective social isolation to accurately gauge health risks.
- Novel measurement of social asymmetry can identify high-risk individuals for targeted health interventions.
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