{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:12:22Z","timestamp":1783743142609,"version":"3.55.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Non-communicable Chronic Diseases"},{"name":"National Science and Technology Major Project of China","award":["2023ZD0519300"],"award-info":[{"award-number":["2023ZD0519300"]}]},{"DOI":"10.13039\/501100010229","name":"Natural Science Foundation of Tianjin Municipal Science and Technology Commission","doi-asserted-by":"publisher","award":["24JCQNJC00610"],"award-info":[{"award-number":["24JCQNJC00610"]}],"id":[{"id":"10.13039\/501100010229","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010104","name":"Tianjin Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010104","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Loneliness is common in ageing population, we aim to identify the association between loneliness and cardiometabolic disease (CMD) across diverse settings, particularly cardiometabolic multimorbidity, and investigate whether unhealthy lifestyles and socioeconomic status (SES) help explain or amplify their relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Data were obtained from six cohort studies across 33 countries, including the China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), Survey of Health, Ageing and Retirement in Europe (SHARE), Korean Longitudinal Study of Aging (KLoSA), and Mexican Health and Aging Study (MHAS). Eligible participants were aged 45 years or older. We applied time-varying Cox mixed-effects regression models to evaluate the association between loneliness and incident cardiometabolic diseases. The mediation role of unhealthy lifestyles and the joint effects of socioeconomic status, unhealthy lifestyles, and loneliness on incident cardiometabolic disease outcomes were also explored. Among 81 978 participants, with a median follow-up of 5 years, 15 750 participants developed CMD. Loneliness was associated with higher risk of any CMD (aHR 1.23, [95% CI: 1.20, 1.26]), with a stronger association for multimorbidity (aHR 1.48, [95% CI: 1.37, 1.60]) than for single CMD (aHR 1.18, [95% CI: 1.15, 1.22]). Unhealthy lifestyles mediated 5.19% (95% CI: 3.06, 7.64) of the association with any CMD. Individuals experiencing a combination of low SES, multiple unhealthy lifestyle factors, and loneliness demonstrated the greatest cardiometabolic disease risk (adjusted HR: 1.89, [95% CI: 1.76, 2.02]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Building on prior evidence that has largely come from single-cohort studies, our findings highlighted loneliness as a global risk factor in predicting the incident CMD, particularly cardiometabolic multimorbidity. The highest risk was observed among socioeconomically disadvantaged individuals with multiple unhealthy lifestyles. These findings underscore the needs to address the combined risk of socioeconomic disadvantage, loneliness, and unhealthy lifestyle in multicomponent health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag330","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:40:42Z","timestamp":1781782842000},"source":"Crossref","is-referenced-by-count":0,"title":["Loneliness, unhealthy lifestyle, and incident cardiometabolic disease among middle-aged and older adults across 33 countries: a multicohort study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-0599","authenticated-orcid":false,"given":"Dorothy Yingxuan","family":"Wang","sequence":"first","affiliation":[{"name":"School of Public Health, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]},{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyao","family":"Xie","sequence":"additional","affiliation":[{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]},{"name":"Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingcui","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Public Health, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]},{"name":"Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]},{"name":"MoE Key Laboratory of Prevention and Control of Major Diseases in the Population, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghui","family":"Sun","sequence":"additional","affiliation":[{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]},{"name":"Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialin","family":"Li","sequence":"additional","affiliation":[{"name":"Staten Island University Hospital, Northwell Health , Staten Island, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinzi","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihao","family":"Guo","sequence":"additional","affiliation":[{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]},{"name":"Centre for Health Systems & Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong , Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Urology, The Eighth Affiliated Hospital of Sun Yat-sen University , No. 3025 Shennan Zhong Road, Futian District, Shenzhen 518033, Guangdong ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-6149","authenticated-orcid":false,"given":"Shi","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]},{"name":"Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]},{"name":"MoE Key Laboratory of Prevention and Control of Major Diseases in the Population, Tianjin Medical University , No. 22 Qixiangtai Rd, Heping District, Tianjin 300070 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phoenix Kit-Han","family":"Mo","sequence":"additional","affiliation":[{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]},{"name":"Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, N.T., Hong Kong SAR 999077 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza Lai-Yi","family":"Wong","sequence":"additional","affiliation":[{"name":"JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese 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