Abstract P166: Social Isolation and Social Support Are Associated With Self-Rated Health and Heart Failure Outcomes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Peter-Marske Kennedy M , Howard Annie G , Evenson Kelly R , Jones Berkeley Sara , Maselko Joanna , Sims Mario , Kucharska-Newton Anna , Russell Stuart D , Sullivan Kevin , Rosamond Wayne D 
Published: May 2024

Introduction:
Social isolation (SI) and social support (SS) are associated with incidence of heart failure (HF). Few studies investigate how SI, SS, and subtypes of SS (appraisal, belonging, self-esteem, and tangible) measured before HF are related to morbidity and mortality after HF.

Objective:
Assess whether SI, SS, and subtypes of SS are associated with self-rated health trajectories and HF outcomes among participants with incident HF hospitalizations, and if results differ by sex or race.

Methods:
We included 2967 ARIC participants (51% female, 27% Black, mean age 59 (SD 6) years) with incident HF hospitalization after Visit 2 (1990-1992). We identified incident HF hospitalization as ICD-9 code 428 in any position and physician adjudicated events; on average HF occurred 17 (SD 8) years after Visit 2. We measured predefined SI categories and tertiles of SS at Visit 2 using the 10-item Lubben Social Network Scale and the 16-item Interpersonal Support Evaluation List, which were assessed as separate exposures. We assessed associations with trajectories of annually measured self-rated health in the 4 years prior to and after incident HF hospitalization, measured by the probability of being in excellent/good self-rated health (0-100% scale), using linear mixed effects models. We calculated hazard ratios (HR) and 95% confidence intervals (CIs) for associations with time to first all-cause rehospitalization and all-cause mortality using Cox proportional hazard models. Models were adjusted for age, sex, race-center, employment status, years of education, prior use of mental health medications, and time between Visit 2 and HF.

Results:
Over mean follow-up of 5 (SD 5) years after initial HF hospitalization, 90% of participants experienced rehospitalization and there were 2378 deaths. Low overall SS had a 5.8% (95% CI 7.8%, 3.8%) lower probability of excellent/good self-rated health over time than high SS; associations of subtypes of SS with this outcome were similar. Low belonging SS was associated with greater days to first rehospitalization (HR 0.85; 95% CI 0.79, 0.96) compared to the highest tertile, however belonging SS was not associated with mortality (HR 1.05; 95% CI 0.95, 1.17). Low tangible SS was associated with greater mortality among White (HR 1.14; 95% CI 1.01, 1.28) but not Black participants (HR 0.95; 95% CI 0.78, 1.16), compared to the highest tertile. Being socially isolated/high risk for SI was associated with greater hazard of all-cause mortality among females (HR 1.57; 95% CI 1.20, 2.06) but not males (HR 0.95; 95% CI 0.75, 1.19), compared to low SI.

Conclusions:
SI and SS measured before HF were relevant to HF outcomes, but relevance may vary by sex and race. In particular, greater SI was only associated with greater mortality among females, and lower tangible SS with greater mortality among White participants only. Belonging support was associated with some HF outcomes but not others.