{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:00:12Z","timestamp":1790359212172,"version":"4.1.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["2U54MD007597"],"award-info":[{"award-number":["2U54MD007597"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Loneliness affects more than half of US adults and has been declared a public health epidemic, yet whether clinically documented loneliness independently predicts mortality across diverse populations remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between clinically documented loneliness and all-cause mortality at 1, 3, and 5 years, overall and by sex, race and ethnicity, and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a propensity score\u2013matched retrospective cohort study using the TriNetX US Collaborative Network, comprising electronic health record data from 65 health care organizations. Adults aged 18\u201390 years with at least one clinical encounter between January 1, 2016, and December 31, 2022, were eligible. Patients with a clinically documented diagnosis of loneliness were matched 1:1 (n\u2009=\u200928,944 per group) on age, sex, race and ethnicity, and 12 comorbidity domains to comparison patients with outpatient engagement and no loneliness diagnosis. The primary outcome was all-cause mortality at 1, 3, and 5 years. Between-group differences were assessed using risk differences, Kaplan-Meier survival analysis, and Cox proportional hazards models, overall and across prespecified subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 57,888 matched adults (mean age, 55.4 years; 62.9% female), loneliness was associated with increased mortality at every horizon: 1-year hazard ratio (HR), 1.52 (95% CI, 1.40\u20131.66); 3-year HR, 1.35 (95% CI, 1.27\u20131.43); and 5-year HR, 1.29 (95% CI, 1.22\u20131.35). Absolute survival gaps widened from 1.57 to 2.82 percentage points. The largest 1-year relative excess occurred among male patients (HR, 1.85) and Hispanic patients (risk ratio, 2.33). Black patients had the greatest 3-year absolute gap (2.49 percentage points). Working-age adults showed sustained excess hazard across all windows (HR, 1.34\u20131.42), whereas older adults had the largest 1-year absolute gap (2.28 percentage points) with convergence by 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinically documented loneliness was independently associated with increased all-cause mortality at 1, 3, and 5 years, with the burden varying by sex, race and ethnicity, and age. These findings identify loneliness as a measurable, independent mortality risk marker and suggest that routine screening and targeted psychosocial intervention warrant prospective evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354773","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:27:01Z","timestamp":1790357221000},"page":"e0354773","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Loneliness and all-cause mortality in the United States"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-3681","authenticated-orcid":true,"given":"Oluwasegun","family":"Akinyemi","sequence":"first","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["The Clive O. 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Callender Outcomes Research Center, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojisola","family":"Fasokun","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Alabama, United States of America"],"department":["Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2825-6896","authenticated-orcid":true,"given":"Ifeoma","family":"Mba-Madubuike","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["The Clive O. Callender Outcomes Research Center, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temitayo","family":"Ogundipe","sequence":"additional","affiliation":[{"name":"Sentara Williamsburg Regional Medical Center","place":["Williamsburg, Virginia, United States of America"],"department":["Department of Hospital Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia","family":"Singleton","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["The Clive O. Callender Outcomes Research Center, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2783-7914","authenticated-orcid":true,"given":"Ayomide","family":"Ogunsakin","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["The Clive O. Callender Outcomes Research Center, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar","family":"Khalil","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["The Clive O. 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Callender Outcomes Research Center, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2478-4650","authenticated-orcid":true,"given":"Miriam","family":"Michael","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kakra","family":"Hughes","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine","place":["Washington, District of Columbia, United States of America"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temitope","family":"Ogundare","sequence":"additional","affiliation":[{"name":"New York Presbyterian Columbia University Medical Center & Columbia University Vagelos College of Physicians and Surgeons","place":["New York, New York, United States of America"],"department":["Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"issue":"5","key":"pone.0354773.ref001","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1177\/15598276211009454","article-title":"Loneliness and social isolation as risk factors: The power of social connection in prevention","volume":"15","author":"J Holt-Lunstad","year":"2021","journal-title":"Am J Lifestyle Med"},{"issue":"10396","key":"pone.0354773.ref002","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0140-6736(23)01411-3","article-title":"Loneliness as a health issue","volume":"402","author":"The Lancet","year":"2023","journal-title":"Lancet"},{"key":"pone.0354773.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-067068","article-title":"The prevalence of loneliness across 113 countries: systematic review and meta-analysis","volume":"376","author":"DL Surkalim","year":"2022","journal-title":"BMJ"},{"key":"pone.0354773.ref004","unstructured":"Our epidemic of loneliness and isolation: the U.S. Surgeon General\u2019s Advisory on the healing effects of social connection and community. 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