The influence of low social support and living alone on premature mortality and hospital utilization among aging Canadians

The first phase of the research involved analyses of a linked database of a large sample of Canadians surveyed in 2001 as part of the Canadian Community Health Survey (CCHS) 1.1 and followed up with recorded death events to December 31, 2011 and hospitalizations to March 31, 2004. Analyses were stratified by two age groups, 55 – 64 (n=6,822) and 65 and older (n=8,966), owing to differing patterns of mortality and health care utilization for these age divisions. Social support measures operationalized several support constructs of interest, including tangible support, affection, emotional and informational support, positive social interactions, living alone, and sense of belonging. Key covariates included sex, age, income, smoking, and a frailty index. In adjusted analyses, compared to adults with the highest levels of support, adults 55 – 64 with low levels of affection had elevated mortality risk (Hazard Ratio (HR) of 1.37 (1.07, 1.75 95% CI)). Effect estimates were similar for low positive social interactions (HR of 1.36 (1.06, 1.75 95% CI)), and low emotional/informational support (HR of 1.36 (1.06, 1.74 95% CI)). Adults 65 and older also had increased mortality risk with low levels of affection (HR of 1.17 (104, 1.31 95% CI)), low positive social interactions (HR of 1.20 (1.07, 1.34 95% CI)), and low emotional/ informational support (HR of 1.19 (1.06, 1.33 95% CI)). Tangible support and living alone were not consistently associated with mortality risk in adjusted analyses which is in keeping with past studies suggesting that tangible support might increase in response to very poor health, and living alone may not inherently put older individuals at risk for mortality. More than one third of respondents 55 – 64 (36.86%) were admitted to hospital over the morbidity follow-up period, and more than half of respondents 65 and older had admissions (54.52%). Hospitalization is not infrequent in older Canadians, especially those over 65. There was a modest signal for elevated odds of hospital admission for adults 65 and older with a weak sense of belonging (Odds Ratio of 1.14 (1.02, 1.28 95% CI)), but otherwise social support variables were not generally associated with an increased risk of admission.Low positive social interactions and living alone were associated with the number of hospital admissions in the younger age group (Incidence Rate Ratio (IRR) of 1.46 (1.08, 1.97 95% CI) and IRR of 1.22 (1.01, 1.48 95% CI) respectively). Respondents reporting low positive social interactions had a predicted number of admissions nearly one and a half times that of respondents reporting the highest positive social interactions. Those living alone had a predicted number of admissions nearly one and a quarter times those living with others. Tangible support, affection, and emotional/informational support were not generally associated with an increased number of admissions in either age group. Low positive social interactions (IRR of 1.73 (1.21, 2.51 95% CI)), low emotional/ informational support (IRR of 1.45 (1.01, 2,05 95% CI)) and living alone (IRR of 1.32 (1.06, 1.65 95% CI)) were all associated with length of stay in hospital in fully adjusted models among the younger cohort. Low levels of affection (IRR of 1.31 (1.08, 1.58 95% CI)), low positive social interactions (IRR of 1.31 (1.07, 1.57 95% CI)), low emotional/informational support (IRR of 1.34 (1.09, 1.61 95% CI)), and a weak sense of belonging (IRR of 1.13 (1,01, 1.27 95% CI)) were all associated with length of stay among the older cohort. Indeed it was length of stay that was the hospitalization measure that was particularly sensitive to multiple social support constructs, suggesting that low social support is implicated in discharge decisions and readmissions.

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