Subjective social isolation or loneliness in older adults residing in social housing in Ontario: a cross-sectional study

Gina Agarwal; Melissa Pirrie; Angela Gao; Ricardo Angeles; Francine Marzanek

doi:10.9778/cmajo.20200205

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Figure 1:
Participant flow diagram.

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Table 1:

Sociodemographic factors, health behaviours and health-related quality of life for all study participants and by social isolation subgroup

Variable	No. (%) of participants
Variable	All participants n = 806	Not socially isolated^* n = 645	Socially isolated^† n = 161
Demographics
Gender
Male	197 (24.4)	154 (23.9)	43 (26.7)
Female	609 (75.6)	491 (76.1)	118 (73.3)
Age, yr
55–64	124 (15.4)	107 (16.6)	17 (10.6)
65–84	517 (64.1)	407 (63.1)	110 (68.3)
≥ 85	153 (19.0)	124 (19.2)	29 (18.0)
No response	12 (1.5)	7 (1.1)	5 (3.1)
Ethnicity
White	603 (74.8)	480 (74.4)	123 (76.4)
Other	203 (25.2)	165 (25.6)	38 (23.6)
Education
Some high school or less	357 (44.3)	293 (45.4)	64 (39.8)
High school diploma	185 (23.0)	151 (23.4)	34 (21.1)
Any postsecondary education	250 (31.0)	192 (29.8)	58 (36.0)
No response	14 (1.7)	9 (1.4)	5 (3.1)
Marital status
Divorced	154 (19.1)	111 (17.2)	43 (26.7)
Common-law	12 (1.5)	5 (0.8)	7 (4.3)
Married	155 (19.2)	140 (21.7)	15 (9.3)
Separated	40 (5.0)	27 (4.2)	13 (8.1)
Single, never married	95 (11.8)	68 (10.5)	27 (16.8)
Widowed	310 (38.5)	259 (40.2)	51 (31.7)
No response	40 (5.0)	35 (5.4)	5 (3.1)
Lives alone	625 (77.5)	489 (75.8)	136 (84.5)
No response	6 (0.7)	5 (0.8)	1 (0.6)
Ontario region^‡
South West	292 (36.2)	223 (34.6)	69 (42.9)
Central West	272 (33.7)	229 (35.5)	43 (26.7)
South East	125 (15.5)	97 (15.0)	28 (17.4)
North East	117 (14.5)	96 (14.9)	21 (13.0)
Income insecure	120 (14.9)	73 (11.3)	47 (29.2)
No response	2 (0.2)	1 (0.2)	1 (0.6)
Has a family doctor	722 (89.6)	573 (88.8)	149 (92.5)
Chronic cardiometabolic disease
Had a stroke or TIA	134 (16.6)	102 (15.8)	32 (19.9)
No response	4 (0.5)	4 (0.6)	0 (0.0)
Had a heart attack	101 (12.5)	78 (12.1)	23 (14.3)
No response	3 (0.4)	2 (0.3)	1 (0.6)
History of hypertension	558 (69.2)	457 (70.9)	101 (62.7)
No response	8 (1.0)	6 (0.9)	2 (1.2)
History of hyperlipidemia	452 (56.1)	369 (57.2)	83 (51.6)
No response	4 (0.5)	2 (0.3)	2 (1.2)
Has diabetes	251 (31.1)	188 (29.1)	63 (39.1)
No response	4 (0.5)	3 (0.5)	1 (0.6)
Health behaviours
Low physical activity	322 (40.0)	234 (36.3)	88 (54.7)
No response	7 (0.9)	6 (0.9)	1 (0.6)
Alcohol drinker	43 (5.3)	29 (4.5)	14 (8.7)
No response	8 (1.0)	7 (1.1)	1 (0.6)
Current smoker	117 (14.5)	77 (11.9)	40 (24.8)
No response	8 (1.0)	6 (0.9)	2 (1.2)
High BMI (overweight or obese)	525 (65.1)	425 (65.9)	100 (62.1)
No response	64 (7.9)	50 (7.8)	14 (8.7)
Health status and quality of life
Self-reported poor to fair health	254 (31.5)	180 (27.9)	74 (46.0)
No response	5 (0.6)	4 (0.6)	1 (0.6)
Mobility problems	411 (51.0)	319 (49.5)	92 (57.1)
No response	7 (0.9)	3 (0.5)	4 (2.5)
Self-care problems	151 (18.7)	105 (16.3)	46 (28.6)
No response	9 (1.1)	4 (0.6)	5 (3.1)
Problems doing usual activities	260 (32.3)	185 (28.7)	75 (46.6)
No response	6 (0.7)	4 (0.6)	2 (1.2)
Pain or discomfort	511 (63.4)	396 (61.4)	115 (71.4)
No response	6 (0.7)	4 (0.6)	2 (1.2)
Anxiety or depression	386 (47.9)	255 (39.5)	114 (70.8)
No response	18 (2.2)	13 (2.0)	5 (3.1)
Social isolation
Isolated	204 (25.3)	59 (9.1)	145 (90.1)
Left out	227 (28.2)	75 (11.7)	152 (94.4)
Lacks companionship	295 (36.6)	142 (22.0)	153 (95.1)

Note: BMI = body mass index, TIA = transient ischemic attack.
↵* Subjective social isolation (loneliness) score less than 6.
↵† Subjective social isolation (loneliness) score of 6 or greater.
↵‡ South West: Grey County, Guelph, Halton Region, Hamilton, Norfolk Region. Central West: Peel Region, York Region. South East: Frontenac County, Hastings Region. North East: Hearst, Iroquois Falls, Matheson, Sudbury, Timmins.

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Table 2:

Univariate and multivariable binomial logistic regression of having self-reported social isolation^*

Variable	Unadjusted OR (95% CI)	Adjusted OR (95% CI)^†
Demographics
Gender
Male	Ref.	Ref.
Female	0.86 (0.58–1.28)	0.88 (0.52–1.50)
Age, yr
55–64	Ref.	Ref.
65–84	1.70 (0.98–2.96)	1.99 (1.01–3.93)
≥ 85	1.47 (0.77–2.83)	2.05 (0.91–4.60)
Ethnicity
White	Ref.	Ref.
Other	0.90 (0.60–1.35)	1.13 (0.67–1.91)
Education
Some high school or less	Ref.	Ref.
High school diploma	1.03 (0.65–1.63)	0.98 (0.57–1.70)
Any postsecondary	1.38 (0.93–2.06)	1.54 (0.94–2.52)
Lives alone
No	Ref.	Ref.
Yes	1.75 (1.09–2.80)	1.72 (0.96–3.09)
Income insecurity
No	Ref.	Ref.
Yes	3.25 (2.14–4.94)	2.10 (1.24–3.53)
Chronic cardiometabolic disease
At least 1 chronic cardiometabolic disease^‡
No	Ref.	Ref.
Yes	0.69 (0.43–1.11)	0.44 (0.24–0.80)
Health behaviours
Physical activity
Inactive	Ref.	Ref.
Active	0.47 (0.33–0.67)	0.47 (0.30–0.73)
Alcohol drinker
No	Ref.	Ref.
Yes	2.01 (1.04–3.91)	2.45 (1.09–5.54)
Smoking status
Nonsmoker	Ref.	Ref.
Current smoker	2.45 (1.60–3.77)	1.42 (0.81–2.51)
Health status and quality of life
General health
Poor to fair	Ref.	Ref.
Good, very good, excellent	0.45 (0.32–0.65)	0.60 (0.38–0.94)
Mobility problems
No problems	Ref.	Ref.
Any problems	1.43 (1.01–2.04)	0.85 (0.51–1.43)
Self-care problems
No problems	Ref.	Ref.
Any problems	2.14 (1.43–3.19)	1.46 (0.80–2.66)
Problems doing usual activities
No problems	Ref.	Ref.
Any problems	2.20 (1.54–3.14)	1.20 (0.69–2.11)
Pain or discomfort
None	Ref.	Ref.
Any problems	1.62 (1.10–2.37)	1.17 (0.73–1.90)
Anxiety or depression
None	Ref.	Ref.
Any problems	7.75 (4.91–12.23)	6.05 (3.65–10.03)

Note: CI = confidence interval, OR = odds ratio, Ref. = reference.
↵* Logistic regressions compare participants who reported being socially isolated (score of ≥ 6) v. not socially isolated (score < 6).
↵† Multivariable regression included participants with complete data (socially isolated n = 141, not socially isolated n = 599).
↵‡ At least 1 of hypertension, hyperlipidemia, heart attack, diabetes, or stroke or transient ischemic attack.

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Table 3:

Univariate and multivariable binomial logistic regression of having self-reported social isolation among participants who live alone^*

Variable	Unadjusted OR (95% CI)	Adjusted OR^† (95% CI)
Demographics
Gender
Male	Ref.	Ref.
Female	0.57 (0.36–0.89)	0.72 (0.39–1.32)
Age, yr
55–64	Ref.	Ref.
65–84	1.90 (1.03–3.49)	2.07 (0.98–4.36)
≥ 85	1.45 (0.70–3.00)	1.78 (0.73–4.36)
Ethnicity
White	Ref.	Ref.
Other	1.04 (0.65–1.66)	1.19 (0.66–2.14)
Education
Some high school or less	Ref.	Ref.
High school diploma	1.18 (0.71–1.96)	1.14 (0.63–2.09)
Any postsecondary	1.53 (0.99–2.37)	1.59 (0.93–2.72)
Income insecurity
No	Ref.
Yes	3.00 (1.91–4.73)	1.93 (1.11–3.37)
Chronic cardiometabolic disease
At least 1 chronic cardiometabolic disease^‡
No	Ref.	Ref.
Yes	0.70 (0.41–1.21)	0.53 (0.27–1.04)
Health behaviours
Physical activity
Inactive	Ref.	Ref.
Active	0.44 (0.30–0.64)	0.45 (0.27–0.73)
Alcohol drinker
No	Ref.	Ref.
Yes	2.22 (1.09–4.53)	3.11 (1.27–7.63)
Smoking status
Nonsmoker	Ref.	Ref.
Current smoker	1.85 (1.15–2.96)	1.10 (0.60–2.01)
Health status and quality of life
General health
Poor to fair	Ref.	Ref.
Good, very good, excellent	0.49 (0.33–0.72)	0.67 (0.41–1.10)
Mobility problems
No problems	Ref.	Ref.
Any problems	1.63 (1.10–2.42)	1.08 (0.62–1.90)
Self-care problems
No problems	Ref.	Ref.
Any problems	1.98 (1.27–3.10)	1.28 (0.67–2.44)
Problems doing usual activities
No problems	Ref.	Ref.
Any problems	2.09 (1.41–3.09)	1.25 (0.67–2.30)
Pain or discomfort
None	Ref.	Ref.
Any problems	1.46 (0.96–2.20)	1.14 (0.68–1.93)
Anxiety or depression
None	Ref.	Ref.
Any problems	8.40 (5.04–13.98)	6.27 (3.59–10.97)

Note: CI = confidence interval, OR = odds ratio, Ref. = reference.
↵* Logistic regressions compare participants who reported being socially isolated (score of ≥ 6) v. not socially isolated (score < 6) among those who live alone.
↵† Multivariable regression included participants with complete data (socially isolated n = 121, not socially isolated n = 457).
↵‡ At least 1 of hypertension, hyperlipidemia, heart attack, diabetes, or stroke or transient ischemic attack.

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Table 4:

Univariate binomial logistic regression of having self-reported social isolation in participants who do not live alone^*

Variable	Unadjusted OR (95% CI)
Demographics
Gender
Male	Ref.
Female	2.04 (0.80–5.21)
Age, yr
55–64	Ref.
65–84	1.63 (0.35–7.66)
≥ 85	2.46 (0.45–13.39)
Ethnicity
White	Ref.
Other	0.86 (0.36–2.09)
Education
Some high school or less	Ref.
High school diploma	0.92 (0.30–2.84)
Any postsecondary	1.10 (0.38–3.15)
Income insecurity
No	Ref.
Yes	4.67 (1.52–14.37)
Chronic cardiometabolic disease
At least 1 chronic cardiometabolic disease^†
No	Ref.
Yes	0.51 (0.18–1.43)
Health behaviour
Physical activity
Inactive	Ref.
Active	0.59 (0.29–1.65)
Alcohol drinker
No	Ref.
Yes	0.89 (0.11–7.61)
Smoking status
Nonsmoker	Ref.
Current smoker	10.21 (3.27–31.89)
Health status and quality of life
General health
Poor to fair	Ref.
Good, very good, excellent	0.37 (0.15–0.91)
Mobility problems
No problems	Ref.
Any problems	0.71 (0.29–1.73)
Self-care problems
No problems	Ref.
Any problems	2.41 (0.90–6.50)
Problems doing usual activities
No problems	Ref.
Any problems	2.43 (1.01–5.87)
Pain or discomfort
No problems	Ref.
Any problems	3.03 (0.99–9.32)
Anxiety or depression
None	Ref.
Any problems	4.99 (1.77–14.07)

Note: CI = confidence interval, OR = odds ratio, Ref. = reference.
↵* Logistic regressions compare participants who reported being socially isolated (score of ≥ 6) v. not socially isolated (score < 6) among those who live alone.
↵† At least 1 of hypertension, hyperlipidemia, heart attack, diabetes, or stroke or transient ischemic attack.