{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:16:23Z","timestamp":1792412183796,"version":"4.4.0"},"reference-count":37,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["101040247"],"award-info":[{"award-number":["101040247"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002341","name":"Research Council of Finland","doi-asserted-by":"publisher","award":["339390"],"award-info":[{"award-number":["339390"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Research Council of Finland","doi-asserted-by":"publisher","award":["354237"],"award-info":[{"award-number":["354237"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010711","name":"Cancer Foundation Finland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010711","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adverse health conditions may serve as intermediate states linking loneliness and social isolation with excess mortality. We examined whether loneliness and social isolation are primarily associated with the risk of developing an adverse health condition or with prognosis after diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort of 236 879 individuals from the UK Biobank was followed from baseline in 2006\u20132010 until death or administrative end of follow-up in 2022. The incidence of three broad categories of adverse health conditions, (1) neoplasms, (2) endocrine, nutritional and metabolic diseases and (3) circulatory diseases, was recorded through self-report or register-based data. Progressive multistate Markov proportional hazards models were used to examine the associations of loneliness and social isolation with transitions from a healthy state to adverse health conditions and mortality, while adjusting for confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Loneliness and social isolation were associated with all three transitions: from a healthy state to adverse health conditions (except for neoplasms), from a healthy state to mortality and from adverse health conditions to mortality. In transitions to adverse health conditions, the HRs were larger for loneliness (HR range 1.12\u20131.17 for loneliness, 1.05\u20131.08 for social isolation). In subsequent transitions to mortality, the HRs were larger for social isolation (1.05\u20131.13 for loneliness, 1.28\u20131.42 for social isolation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While both loneliness and social isolation were associated with the onset and prognosis of adverse health conditions, our findings highlight the associations of social isolation, in particular, with mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2025-224665","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:20:33Z","timestamp":1766082033000},"page":"237-244","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Loneliness and social isolation in transitions to adverse health conditions and mortality: an analysis of data from the UK Biobank study"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1576-7111","authenticated-orcid":false,"given":"Kaisla","family":"Komulainen","sequence":"first","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2055-170X","authenticated-orcid":false,"given":"Ripsa","family":"Niemi","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0534-9222","authenticated-orcid":false,"given":"Mai","family":"Gutvilig","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5712-4475","authenticated-orcid":false,"given":"Laura","family":"Cach\u00f3n Alonso","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8629-9960","authenticated-orcid":false,"given":"Christian","family":"Hakulinen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1401-1910","authenticated-orcid":false,"given":"Marko","family":"Elovainio","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2026031002150949000_80.4.237.1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0140-6736(23)01411-3","article-title":"Loneliness as a health issue","volume":"402","year":"2023","journal-title":"The Lancet"},{"key":"2026031002150949000_80.4.237.2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-052020-110732"},{"key":"2026031002150949000_80.4.237.3","first-page":"31","article-title":"Toward a social psychology of loneliness","volume":"3","author":"Perlman","year":"1981","journal-title":"Pers Relatsh"},{"key":"2026031002150949000_80.4.237.4","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1038\/s41562-023-01617-6","article-title":"A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality","volume":"7","author":"Wang","year":"2023","journal-title":"Nat Hum Behav"},{"key":"2026031002150949000_80.4.237.5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308790"},{"key":"2026031002150949000_80.4.237.6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312663"},{"key":"2026031002150949000_80.4.237.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-020-05258-6"},{"key":"2026031002150949000_80.4.237.8","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2023.102236","article-title":"Social isolation, loneliness, and incident type 2 diabetes mellitus: results from two large prospective cohorts in Europe and East Asia and Mendelian randomization","volume":"64","author":"Song","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2026031002150949000_80.4.237.9","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmph.2021.100826","article-title":"Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: A nationwide registry study","volume":"15","author":"Elovainio","year":"2021","journal-title":"SSM Popul Health"},{"key":"2026031002150949000_80.4.237.10","doi-asserted-by":"crossref","first-page":"113868","DOI":"10.1016\/j.psychres.2021.113868","article-title":"Loneliness and social isolation increase cancer incidence in a cohort of Finnish middle-aged men. A longitudinal study","volume":"299","author":"Kraav","year":"2021","journal-title":"Psychiatry Res"},{"key":"2026031002150949000_80.4.237.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2009.06.003"},{"key":"2026031002150949000_80.4.237.12","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-2144"},{"key":"2026031002150949000_80.4.237.13","doi-asserted-by":"crossref","DOI":"10.1136\/gpsych-2023-101153","article-title":"Social isolation, loneliness and subsequent risk of major adverse cardiovascular events among individuals with type 2 diabetes mellitus","volume":"36","author":"Liang","year":"2023","journal-title":"Gen Psych"},{"key":"2026031002150949000_80.4.237.14","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1080\/13607863.2019.1655704","article-title":"Longitudinal analysis of the impact of loneliness on cognitive function over a 20-year follow-up","volume":"24","author":"Wang","year":"2020","journal-title":"Aging & Mental Health"},{"key":"2026031002150949000_80.4.237.15","doi-asserted-by":"crossref","first-page":"3092","DOI":"10.1111\/jgs.17343","article-title":"Loneliness and health expectancy among older adults: A longitudinal population\u2010based study","volume":"69","author":"Malhotra","year":"2021","journal-title":"J American Geriatrics Society"},{"key":"2026031002150949000_80.4.237.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18975-z","article-title":"Loneliness shapes disparities in healthy life expectancy: a multi-state analysis from China","volume":"24","author":"Yu","year":"2024","journal-title":"BMC Public Health"},{"key":"2026031002150949000_80.4.237.17","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Ferrari","year":"2024","journal-title":"The Lancet"},{"key":"2026031002150949000_80.4.237.18","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(24)00367-2"},{"key":"2026031002150949000_80.4.237.19","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/S2468-2667(17)30075-0","article-title":"Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study","volume":"2","author":"Elovainio","year":"2017","journal-title":"Lancet Public Health"},{"key":"2026031002150949000_80.4.237.20","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(22)00253-5"},{"key":"2026031002150949000_80.4.237.21","unstructured":"First occurrence of health outcomes defined by 3-character ICD10 code. 2019. Available: https:\/\/biobank.ndph.ox.ac.uk\/ukb\/ukb\/docs\/first_occurrences_outcomes.pdf"},{"key":"2026031002150949000_80.4.237.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2712"},{"key":"2026031002150949000_80.4.237.23","doi-asserted-by":"publisher","DOI":"10.1007\/s11229-021-03276-4"},{"key":"2026031002150949000_80.4.237.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1267"},{"key":"2026031002150949000_80.4.237.25","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.3233\/JAD-180439","article-title":"The Association between Social Engagement, Loneliness, and Risk of Dementia: A Systematic Review and Meta-Analysis","volume":"66","author":"Penninkilampi","year":"2018","journal-title":"J Alzheimers Dis"},{"key":"2026031002150949000_80.4.237.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053936","article-title":"Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank Cohort Study","volume":"12","author":"Elovainio","year":"2022","journal-title":"BMJ Open"},{"key":"2026031002150949000_80.4.237.27","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1016\/S2468-2667(19)30226-9","article-title":"Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study","volume":"5","author":"Dugravot","year":"2020","journal-title":"Lancet Public Health"},{"key":"2026031002150949000_80.4.237.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38693.435301.80"},{"key":"2026031002150949000_80.4.237.29","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.45"},{"key":"2026031002150949000_80.4.237.30","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1093\/geronb\/gbad122","article-title":"Social Isolation and Worsening Health Behaviors Among Older Adults During the COVID-19 Pandemic","volume":"78","author":"Choi","year":"2023","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"2026031002150949000_80.4.237.31","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kax033"},{"key":"2026031002150949000_80.4.237.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002571","article-title":"Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study","volume":"15","author":"Singh-Manoux","year":"2018","journal-title":"PLoS Med"},{"key":"2026031002150949000_80.4.237.33","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313844"},{"key":"2026031002150949000_80.4.237.34","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1016\/S2468-2667(19)30248-8","article-title":"Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study","volume":"5","author":"Kivim\u00e4ki","year":"2020","journal-title":"Lancet Public Health"},{"key":"2026031002150949000_80.4.237.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m131","article-title":"Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis","volume":"368","author":"Batty","year":"2020","journal-title":"BMJ"},{"key":"2026031002150949000_80.4.237.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)33067-8"},{"key":"2026031002150949000_80.4.237.37","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1038\/s41562-024-01970-0","article-title":"Observational and genetic evidence disagree on the association between loneliness and risk of multiple diseases","volume":"8","author":"Liang","year":"2024","journal-title":"Nat Hum Behav"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2025-224665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:15:31Z","timestamp":1773134131000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2025-224665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/jech-2025-224665"],"URL":"https:\/\/doi.org\/10.1136\/jech-2025-224665","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}