中国中老年人社交隔离和孤独与心血管疾病发病风险的关联研究

摘要： 背景 心血管疾病是我国乃至全球居民死亡的主要原因，社交隔离和孤独与心血管健康密切相关。然而，目前的研究聚焦于欧洲人群，且研究结果并不一致。在中国人群中，尚未有充分证据同时探讨社交隔离和孤独感对心血管疾病发病风险的影响。 目的 探讨中国中老年人社交隔离和孤独与心血管疾病发病风险的独立和联合关联。 方法 本研究的开展时间为2024年8月，研究对象来自中国健康与养老追踪调查，剔除基线患有心脏疾病和卒中者，纳入10 668人进行分析。基于基线问卷信息定义社交隔离和孤独感，基于随访问卷的疾病相关数据定义心血管疾病发病，采用Cox比例风险回归模型进行统计分析。 结果 研究人群中位随访8.9年，随访期间新发心血管疾病2 409例（22.58%），心脏疾病1 777例（16.66%），卒中896例（8.40%）。Cox比例风险回归分析结果显示，调整了多种混杂因素后，与非孤独者相比，孤独者发生心血管疾病、心脏疾病、卒中的风险分别增加24%（HR=1.24，95%CI=1.13~1.35）、24%（HR=1.24，95%CI=1.12~1.38）和26%（HR=1.26，95%CI=1.09~1.45）；与非社交隔离者相比，社交隔离者发生卒中的风险增加16%（HR=1.16，95%CI=1.01~1.33），社交隔离与心血管疾病、心脏疾病发病风险间未见统计学关联（P>0.05）。社交隔离和孤独与心血管疾病及其亚型的发病风险之间未见交互作用（P>0.05）。社交隔离且孤独者发生心血管疾病的风险最高（HR=1.23，95%CI=1.09~1.39），其中卒中的风险尤为显著（HR=1.49，95%CI=1.23~1.80）。 结论 主观感知的孤独是心血管疾病及其亚型发病的独立危险因素，与客观评估的社交隔离同时存在时心血管疾病发病风险最高。本研究结果提示鼓励中老年人群维持活跃的社交联系、打破孤独感对心血管健康具有重要作用。

关键词: 社交隔离, 孤独, 心血管疾病, 前瞻性研究, 队列研究

Abstract:

Background

Cardiovascular diseases (CVD) are a leading cause of death both in China and worldwide. Social isolation and loneliness are closely associated with cardiovascular health. However, current research has mainly focused on European populations, and the findings are inconsistent. In China, evidence simultaneously examining the impact of social isolation and loneliness on the risk of incident CVD remains limited.

Objective

To investigate the independent and joint associations of social isolation and loneliness with the risk of CVD among middle-aged and older Chinese populations.

Methods

This prospective study, initiated in August 2024, included 10 668 participants from the China Health and Retirement Longitudinal Study who were free of heart disease and stroke at baseline. Social isolation and loneliness were assessed using baseline questionnaires. Incident CVD events were identified based on follow-up survey data. Cox proportional hazards regression models were used to estimate the associations between social isolation, loneliness, and CVD risk.

Results

During a median follow-up of 8.9 years, 2 409 (22.58%) participants developed CVD, including 1 777 cases (16.66%) of heart disease and 896 cases (8.40%) of stroke. The Cox proportional hazards regression analysis showed that, after adjustment for multiple confounders, compared to non-lonely individuals, lonely individuals had a 24% increased risk of CVD (HR=1.24, 95%CI=1.13-1.35), a 24% increased risk of heart disease (HR=1.24, 95%CI=1.12-1.38), and a 26% increased risk of stroke (HR=1.26, 95%CI=1.09-1.45). Compared to non-socially isolated individuals, socially isolated individuals had a 16% increased risk of stroke (HR=1.16, 95%CI=1.01-1.33), but show no significant association was found between social isolation and the risk of CVD or heart disease (P>0.05). No significant interaction was observed between social isolation, loneliness, and the risk of CVD or its subtypes (P>0.05). Participants who experienced both social isolation and loneliness had the highest risk of CVD (HR=1.23, 95%CI=1.09-1.39), particularly for stroke (HR=1.49, 95%CI=1.23-1.80).

Conclusion

Subjectively perceived loneliness is an independent risk factor for the incidence of CVD and its subtypes, with the highest risk observed when loneliness coexists with objectively assessed social isolation. The findings of this study suggest that encouraging middle-aged and older adults to maintain active social connections and alleviate feelings of loneliness play an important role in promoting cardiovascular health.

Key words: Social isolation, Loneliness, Cardiovascular disease, Prospective study, Cohort study

引用本文

的机卓玛,邹雁秋,郑迪心,等. 中国中老年人社交隔离和孤独与心血管疾病发病风险的前瞻性关联研究[J]. 中国全科医学, 2026, 29(01): 122-128.