Social and physical isolation, along with financial hardship, are linked to lower uptake of recommended preventive health services, investigators at Cambridge Health Alliance and Harvard Medical School report this week in the Annals of Family Medicine.
The team mined data from the 2022 Behavioral Risk Factor Surveillance System phone survey to assess the association between self-reported social and physical isolation (using transportation barriers as a proxy for the latter), material deprivation (financial strain, inadequate health care access), and uptake of COVID-19, influenza, and pneumococcal vaccinations and cervical, colorectal, and breast cancer screening among US adults.
A lack of social connections has been linked to higher all-cause death rates, adverse cardiovascular outcomes, high blood pressure, complications of diabetes, depression, suicide, and other adverse effects. “The mechanism of these associations may involve different aspects of isolation that limit meaningful social connections, including social, physical, and emotional dimensions,” the authors wrote.
Isolation declined as income rose
Of 281,592 adult respondents who responded to questions about isolation and transportation difficulties, 31.9% reported social isolation, and 8.2% said they were physically isolated.
Average rates of physical isolation were higher among participants from southern and southwestern states, Alaska, and territories. States with higher rates of physical isolation tended to also have more social isolation.
For social isolation, isolated adults were younger than their non-isolated counterparts (average age, 44.8 vs 50.9 years, respectively), and for physical isolation, the average age was 42.8 versus 49.6 years, respectively. Relative to non-isolated participants, isolated respondents were more likely to be Black, American Indian, or Hispanic; single; and less educated. But rates of living in an urban versus rural county were comparable across groups.
In total, 63.9% of physically isolated adults were socially isolated, compared with 29.0% of those who were not physically isolated. Both isolation types were more common among low-income adults and steadily declined as income rose.
Physical and social isolation were both tied to material deprivation. For example, 82.1% of physically isolated respondents and 30.9% of those who didn’t cite physical isolation experienced financial difficulty, including food insecurity and problems paying housing or utility bills, sometimes facing utility shutoff.
Policy efforts may be needed in multiple areas
Before adjustment, both physical and social isolation were associated with a lower likelihood of receiving most preventive health services.
After multivariate adjustment, social isolation was still tied to lower use of breast cancer screening (adjusted odds ratio [aOR], 0.70) and colorectal cancer screening (aOR, 0.91), and physical isolation was still linked to reduced uptake of flu vaccination (aOR, 0.89) and screening for breast cancer (aOR, 0.57) and colorectal cancer (aOR, 0.81). Other associations were smaller or no longer statistically significant.
The complexity of possible causal pathways suggest that policy efforts may be needed on multiple fronts to mitigate the health harms of isolation.
“These findings suggest that financial hardship explains part of the relationship between isolation and preventive care use and highlight the importance of attending social and physical isolation alongside material needs when counseling patients about prevention,” the researchers wrote.
The association between material deprivation and suboptimal use of preventive health services, they said, may be due to an inability to afford care, work-related time pressures, psychological stressors, and other factors, while deprivation itself may lead to social isolation.
“The complexity of possible causal pathways suggest that policy efforts may be needed on multiple fronts to mitigate the health harms of isolation,” the authors wrote. “Taxi vouchers, mobile vans, or other transportation services are interventions that may improve preventive care uptake among physically isolated patients, although empiric data on the impact of these interventions are limited.”
