{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:29:48Z","timestamp":1793316588151,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,7,25]],"date-time":"2021-07-25T00:00:00Z","timestamp":1627171200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["RO1AG17644"],"award-info":[{"award-number":["RO1AG17644"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Living alone has been associated with increased mortality risk, but it is unclear whether this is a result of a selection effect or the impact of stressful life changes such as widowhood or divorce leading to changes in living arrangements. We therefore examined the association between living alone, transitions in living arrangements and all-cause mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>We analysed data from 4,888 individuals who participated in both wave 2 (2004\u20132005) and wave 4 (2008\u20132009) of the English Longitudinal Study of Ageing. Transitions in living arrangements over this period were identified. Mortality status was ascertained from linked national mortality registers. Cox proportional hazards analysis was used to examine the association between living alone and mortality over an average 8.5\u00a0year follow-up period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>An association was found between living alone at wave 4 and mortality (hazard ratio (HR): 1.20, 95% CI 1.04\u20131.38) in a model adjusted for multiple factors including socioeconomic status, physical health, health behaviours and loneliness. We also found that participants who moved to living alone after divorce or bereavement had a higher risk of mortality compared with those who lived with others at both time points (HR: 1.34, 95% CI 1.01\u20131.79), while those who moved to living alone for other reasons did not show an increased mortality risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The relationship between living alone and mortality is complicated by the reasons underlying not living with others. A greater understanding of these dynamics will help to identify the individuals who are at particular health risk because of their living arrangements.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afab155","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T11:12:57Z","timestamp":1625483577000},"page":"2019-2024","source":"Crossref","is-referenced-by-count":53,"title":["Why is living alone in older age related to increased mortality risk? A longitudinal cohort study"],"prefix":"10.1093","volume":"50","author":[{"given":"Jessica G","family":"Abell","sequence":"first","affiliation":[{"name":"Department of Behavioural Science and Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Steptoe","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"2021111107292017300_ref1","volume-title":"The Cost of Living Alone","author":"Office for National Statistics","year":"2019"},{"key":"2021111107292017300_ref2","volume-title":"Ageing Europe - Stastistics on Housing and Living Conditions","author":"Eurostat","year":"2020"},{"key":"2021111107292017300_ref3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000316","article-title":"Social relationships and mortality risk: a meta-analytic review","volume":"7","author":"Holt-Lunstad","year":"2010","journal-title":"PLoS Med"},{"key":"2021111107292017300_ref4","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":"2021111107292017300_ref5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/ehjqcco\/qcz014","article-title":"Living alone and mortality: more complicated than it seems","volume":"5","author":"Abell","year":"2019","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2021111107292017300_ref6","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1001\/jamainternmed.2013.1597","article-title":"Living alone and risk of mortality in older, community-dwelling adults","volume":"173","author":"Gopinath","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2021111107292017300_ref7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1186\/1471-2458-7-335","article-title":"Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study","volume":"7","author":"Kandler","year":"2007","journal-title":"BMC Public Health"},{"key":"2021111107292017300_ref8","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/eurpub\/ckv052","article-title":"Impact of living alone on institutionalization and mortality: a population-based longitudinal study","volume":"26","author":"Pimouguet","year":"2016","journal-title":"Eur J Public Health"},{"key":"2021111107292017300_ref9","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/00006842-200103000-00005","article-title":"Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety","volume":"63","author":"Lane","year":"2001","journal-title":"Psychosom Med"},{"key":"2021111107292017300_ref10","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1093\/ehjqcco\/qcz004","article-title":"Living alone is associated with all-cause and cardiovascular mortality: 32 years of follow-up in the Copenhagen Male Study","volume":"5","author":"Jensen","year":"2019","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2021111107292017300_ref11","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-77104-z","article-title":"A longitudinal analysis of loneliness, social isolation and falls amongst older people in England","volume":"10","author":"Bu","year":"2020","journal-title":"Sci Rep"},{"key":"2021111107292017300_ref12","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1136\/thoraxjnl-2019-214445","article-title":"Social isolation and loneliness as risk factors for hospital admissions for respiratory disease among older adults","volume":"75","author":"Bu","year":"2020","journal-title":"Thorax"},{"key":"2021111107292017300_ref13","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12883-016-0599-y","article-title":"Living alone predicts mortality in patients with ischemic stroke before 70 years of age: a long-term prospective follow-up study","volume":"16","author":"Redfors","year":"2016","journal-title":"BMC Neurol"},{"key":"2021111107292017300_ref14","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1136\/heartjnl-2019-315460","article-title":"Significantly increased risk of all-cause mortality among cardiac patients feeling lonely","volume":"106","author":"Christensen","year":"2020","journal-title":"Heart"},{"key":"2021111107292017300_ref15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s10680-017-9423-7","article-title":"Mortality differences by partnership status in England and Wales: the effect of living arrangements or health selection?","volume":"34","author":"Franke","year":"2018","journal-title":"Eur J Popul"},{"key":"2021111107292017300_ref16","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/PSY.0000000000000168","article-title":"Divorce and health: current trends and future directions","volume":"77","author":"Sbarra","year":"2015","journal-title":"Psychosom Med"},{"key":"2021111107292017300_ref17","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.socscimed.2015.01.010","article-title":"Social contact frequency and all-cause mortality: a meta-analysis and meta-regression","volume":"128","author":"Shor","year":"2015","journal-title":"Soc Sci Med"},{"key":"2021111107292017300_ref18","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1093\/ije\/dys168","article-title":"Cohort profile: English Longitudinal Study of Ageing","volume":"42","author":"Steptoe","year":"2013","journal-title":"Int J Epidemiol"},{"key":"2021111107292017300_ref19","first-page":"71","volume-title":"Health, Wealth and Lifestyles of the Older Population in England","author":"Banks","year":"2003"},{"key":"2021111107292017300_ref20","doi-asserted-by":"crossref","first-page":"792","DOI":"10.2337\/dc09-1663","article-title":"Depressive symptoms and risk of type 2 diabetes in a national sample of middle-aged and older adults: the English longitudinal study of aging","volume":"33","author":"Demakakos","year":"2010","journal-title":"Diabetes Care"},{"key":"2021111107292017300_ref21","first-page":"207","volume-title":"Health, Wealth and Lifestyles of the Older Population in England","author":"McMunn","year":"2003"},{"key":"2021111107292017300_ref22","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1177\/0164027504268574","article-title":"A short scale for measuring loneliness in large surveys: results from two population-based studies","volume":"26","author":"Hughes","year":"2004","journal-title":"Res Aging"},{"key":"2021111107292017300_ref23","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1002\/(SICI)1097-0258(19970715)16:13<1515::AID-SIM572>3.0.CO;2-1","article-title":"Estimating the proportion of treatment effect explained by a surrogate marker","volume":"16","author":"Lin","year":"1997","journal-title":"Stat Med"},{"key":"2021111107292017300_ref24","article-title":"The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing","volume":"367","author":"Fancourt","year":"2019","journal-title":"Br Med J"},{"key":"2021111107292017300_ref25","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1146\/annurev-psych-122216-011902","article-title":"Why social relationships are important for physical health: a systems approach to understanding and modifying risk and protection","volume":"69","author":"Holt-Lunstad","year":"2018","journal-title":"Annu Rev Psychol"},{"key":"2021111107292017300_ref26","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1192\/bjp.2019.74","article-title":"The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis","volume":"215","author":"Wei","year":"2019","journal-title":"Br J Psychiatry"},{"key":"2021111107292017300_ref27","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.2010.1923","article-title":"Gait speed and survival in older adults","volume":"305","author":"Studenski","year":"2011","journal-title":"JAMA"},{"key":"2021111107292017300_ref28","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/abm\/kay038","article-title":"Smoking and physical activity explain the increased mortality risk following marital separation and divorce: evidence from the English Longitudinal Study of Ageing","volume":"53","author":"Bourassa","year":"2019","journal-title":"Ann Behav Med"},{"key":"2021111107292017300_ref29","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/abm\/kax033","article-title":"Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study","volume":"52","author":"Kobayashi","year":"2018","journal-title":"Ann Behav Med"},{"key":"2021111107292017300_ref30","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/PSY.0000000000000798","article-title":"Marital status, close relationships, and all-cause mortality: results from a 10-year study of nationally representative older adults","volume":"82","author":"Manvelian","year":"2020","journal-title":"Psychosom Med"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/50\/6\/2019\/41119507\/afab155.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/50\/6\/2019\/41119507\/afab155.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T07:29:54Z","timestamp":1636615794000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/50\/6\/2019\/6326082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,23]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,7,23]]},"published-print":{"date-parts":[[2021,11,10]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afab155","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11]]},"published":{"date-parts":[[2021,7,23]]}}}