Social Isolation Increases Risk of Premature Death for IBD Patients

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Recent qualitative studies found social isolation in patients with IBD is 1 of the main obstacles to leading a normal life.

The negative consequence of social isolation is fairly well known, but new data show patients with inflammatory bowel disease (IBD) who are socially isolated are at an increased risk of premature mortality.

A team, led by Jie Chen, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, examined the joint association of social isolation and IBD with premature deaths.

Social Isolation

While research on the impact of social isolation continues to expand, the effect of social isolation on patients with IBD remains poorly understood. A recent analysis shows social isolation in patients with IBD is 1 of the main obstacles to leading a normal life.

However, this information thus far is largely limited to qualitative studies that could capture patients more prone to social isolation because of disease-related stress, negative perception of social support, lack of public awareness, and surrounding stigma.

“Patients with IBD are known to have distressing and severe physical symptoms such as abdominal pain, diarrhea, fecal urgency, weight loss, and rectal bleeding,” the authors wrote. “These can cause emotional and social stress that persists even during remission periods, contributing to the deterioration of the quality of life.”

Data on Mortality

In the longitudinal cohort study, the investigators identified the data of 486,014 patients from the UK Biobank, including 5791 individuals with IBD. There was a mean follow-up of 11.84 years with 32,390 incident cases of all-cause mortality documented. The mean age of the patient population was 56.5 years.

In addition, 10.4% (n = 600) of patients with IBD and 9.2% (n = 44,401) of non-IBD participants were socially isolated.

Each patient’s IBD diagnosis and subtype was confirmed using a combination of self-reporting, primary care, and hospital admission data. The investigators also measured social isolation by the frequency of meeting family and friends, leisure and social activity, and communal or solitary living.

The team also obtained mortality information through data linkage with national death registries.

To analyze this data, the team conducted multivariable Cox regression models to estimate hazard ratios and 95% confidence intervals.

Hazard Ratios and Excess Risk of Death

The hazard ratios of mortality for patients with IBD who were socially isolated was 2.06 (95% CI, 1.69-2.51) compared to a non-isolated non-IBD population. The hazard ratio for patients with IBD who were not socially isolated was 1.33 (95% CI, 1.21-1.45).

The excess risk of death was found in socially isolated patients with IBD (HR, 1.69; 95% CI, 1.36-2.11). This was particularly strong among patients with Crohn’s disease (HR, 2.06; 95% CI, 1.48-2.87) than patients with Crohn’s disease who were not socially isolated.

Subgroup and sensitivity data analyses were consistent from the data from the primary analysis.

“Patients with IBD, especially CD, are more likely to be affected when socially isolated, associating with a higher risk of early death in patients with CD,” the authors wrote. “Therefore, social isolation merits attention, and targeted social support strategies and interventions ought to be devised.”

The investigators suggest future studies look at the differing consequences of social isolation between different IBD subtypes.

The study, “Associations between inflammatory bowel disease, social isolation, and mortality: evidence from a longitudinal cohort study,” was published online in Therapeutic Advances in Gastroenterology.