{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:24:10Z","timestamp":1788312250479,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007343","name":"Shire plc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007343","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004426","name":"Atlantic Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004426","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["ILP-PHR-2017-022"],"award-info":[{"award-number":["ILP-PHR-2017-022"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social distancing and similar measures in response to the coronavirus disease 2019 pandemic have greatly increased loneliness and social isolation among older adults. Understanding the association between loneliness and mortality is therefore critically important. We examined whether combinations of loneliness and social isolation, using a metric named social asymmetry, was associated with increased mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The sample was derived from participants in The Irish Longitudinal Study on Ageing, a nationally representative sample of community-dwelling older adults aged \u226550. Survey data were linked to official death registration records. Cox proportional hazards regressions and competing risk survival analyses were used to examine the association between social asymmetry and all-cause and cause-specific mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of four social asymmetry groups, concordant low lonely (low loneliness, low isolation) included 35.5% of participants; 26.4% were concordant high lonely (high loneliness, high isolation); 19.2% were discordant robust (low loneliness, high isolation) and 18.9% discordant susceptible (high loneliness, low isolation). The concordant high lonely (hazard ratio [HR]\u2009=\u20091.43, 95% confidence interval [CI]: 1.09\u20131.87) and discordant robust (HR\u2009=\u20091.37, 95% CI: 1.04\u20131.81) groups had an increased mortality risk compared to those in the concordant low lonely group. The concordant high lonely group had an increased risk of mortality due to diseases of the circulatory system (sub-distribution hazard ratio\u2009=\u20091.52, 95% CI: 1.03\u20132.25).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found that social asymmetry predicted mortality over a 7-year follow-up period. Our results confirm that a mismatch between subjective loneliness and objective social isolation, as well as the combination of loneliness and social isolation, were associated with an increased all-cause mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afab004","type":"journal-article","created":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T06:26:54Z","timestamp":1610173614000},"page":"1329-1335","source":"Crossref","is-referenced-by-count":67,"title":["Mortality risk associated with combinations of loneliness and social isolation. Findings from The Irish Longitudinal Study on Ageing (TILDA)"],"prefix":"10.1093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6309-4866","authenticated-orcid":false,"given":"Mark","family":"Ward","sequence":"first","affiliation":[{"name":"The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"May","sequence":"additional","affiliation":[{"name":"Centre for Health Policy and Management, Trinity College Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Normand","sequence":"additional","affiliation":[{"name":"Centre for Health Policy and Management, Trinity College Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose Anne","family":"Kenny","sequence":"additional","affiliation":[{"name":"The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland"},{"name":"Department of Medical Gerontology, Trinity College Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Nolan","sequence":"additional","affiliation":[{"name":"The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland"},{"name":"The Economic and Social Research Institute (ESRI), Whitaker Square Sir John Rogerson\u2019s Quay, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"2021063014132452400_ref1","first-page":"311","article-title":"Poor health and loneliness in later life: the role of depressive symptoms, social resources, and rural environments","volume":"69","author":"Burholt","year":"2014","journal-title":"J Gerontol - Ser B Psychol Sci Soc Sci"},{"key":"2021063014132452400_ref2","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1177\/0898264312460275","article-title":"Social isolation, loneliness and health among older adults","volume":"24","author":"Coyle","year":"2012","journal-title":"J Aging Health"},{"key":"2021063014132452400_ref3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/1088868319850738","article-title":"The stability and change of loneliness across the life span: a meta-analysis of longitudinal studies","volume":"24","author":"Mund","year":"2020","journal-title":"Pers Soc Psychol Rev"},{"key":"2021063014132452400_ref4","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1093\/ageing\/afx188","article-title":"Social isolation and loneliness as risk factors for the progression of frailty: the English longitudinal study of ageing","volume":"47","author":"Gale","year":"2018","journal-title":"Age Ageing"},{"key":"2021063014132452400_ref5","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/ageing\/afaa168","article-title":"Social isolation and loneliness as related to progression and reversion of frailty in the survey of health aging retirement in Europe (SHARE)","volume":"50","author":"Jarach","year":"2021","journal-title":"Age Ageing"},{"key":"2021063014132452400_ref6","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/1745691614568352","article-title":"Loneliness and social isolation as risk factors for mortality: a meta-analytic review","volume":"10","author":"Holt-Lunstad","year":"2015","journal-title":"Perspect Psychol Sci"},{"key":"2021063014132452400_ref7","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1017\/S1041610220000988","article-title":"Loneliness and social isolation during the COVID-19 pandemic","volume":"32","author":"Hwang","year":"2020","journal-title":"Int Psychogeriatr"},{"key":"2021063014132452400_ref8","volume-title":"Loneliness and social isolation in the COVID-19 Pandemic among the over 70s: Data from The Irish Longitudinal Study on Ageing (TILDA) and\u2009ALONE","author":"Ward","year":"2020"},{"key":"2021063014132452400_ref9","first-page":"154","article-title":"Social isolation and loneliness among older adults in the context of COVID-19: a global challenge","volume":"5","author":"Wu","year":"2020","journal-title":"Global Health Res Pol"},{"key":"2021063014132452400_ref10","doi-asserted-by":"crossref","first-page":"5797","DOI":"10.1073\/pnas.1219686110","article-title":"Social isolation, loneliness, and all-cause mortality in older men and women","volume":"110","author":"Steptoe","year":"2013","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2021063014132452400_ref11","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1093\/oxfordjournals.aje.a112674","article-title":"Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents","volume":"109","author":"Berkman","year":"1979","journal-title":"Am J Epidemiol"},{"key":"2021063014132452400_ref12","first-page":"475","article-title":"Loneliness and all-cause, cardiovascular, and noncardiovascular mortality in older men: the Zutphen elderly study. 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