Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?

Authors

  • S. Ryan Greysen MD, MHS, MA,

    Corresponding author
    1. Divisions of Hospital Medicine, University of California at San Francisco, San Francisco, California
    • Address correspondence to S. Ryan Greysen, Division of Hospital Medicine, University of California at San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA 94113. E-mail: Ryan.Greysen@ucsf.edu

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  • Leora I. Horwitz MD, MHS,

    1. Division of General Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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  • Kenneth E. Covinsky MD, MPH,

    1. Divisions of Geriatrics, University of California at San Francisco, San Francisco, California
    2. San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Kirsha Gordon MS,

    1. West Haven Veterans Affairs Medical Center, West Haven, Connecticut
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  • Michael E. Ohl MD, MSPH,

    1. Division of Infectious Diseases, School of Medicine, University of Iowa, Iowa City, Iowa
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  • Amy C. Justice MD, PhD

    1. Division of General Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
    2. West Haven Veterans Affairs Medical Center, West Haven, Connecticut
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Abstract

Objectives

To compare levels of social isolation in aging veterans with and without the human immunodeficiency virus (HIV) and determine associations with hospital admission and mortality.

Design

Longitudinal data analysis.

Setting

The Veterans Aging Cohort Study (VACS), at eight VA Medical Centers nationally.

Participants

Veterans aged 55 and older enrolled in VACS from 2002 to 2008 (N = 1,836).

Measurements

A Social Isolation Score (SIS) was created using baseline survey responses about relationship status; number of friends and family and frequency of visits; and involvement in volunteer work, religious or self-help groups, and other community activities. Scores were compared according to age and HIV status, and multivariable regression was used to assess effects of SIS on hospital admission and all-cause mortality.

Results

Mean SIS was higher for HIV-positive (HIV+) individuals, with increasing difference according to age (P = .01 for trend). Social isolation was also more prevalent for HIV+ (59%) than uninfected participants (51%, P < .001). In multivariable regression analysis of HIV+ and uninfected groups combined, adjusted for demographic and clinical features, isolation was independently associated with greater risk of incident hospitalization (hazard rate (HR) = 1.25, 95% confidence interval (CI) = 1.09–1.42) and risk of all-cause mortality (HR=1.28, 95% CI = 1.06–1.54). Risk estimates calculated for HIV+ and uninfected groups separately were not significantly different.

Conclusion

Social isolation is associated with greater risk of hospitalization and death in HIV+ and uninfected older veterans. Despite similar effects in both groups, the population-level effect of social isolation may be greater in those who are HIV+ because of the higher prevalence of social isolation, particularly in the oldest individuals.

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