Introduction and Objective: We evaluated the association between social isolation, loneliness, and stroke risk in individuals with diabetes (DM) (vs. euglycemia) and assessed sex differences in the association.Methods: We included participants with DM (N=40,684) (defined by self-reported DM diagnosis, DM medication, HbA1c>6.5%, ICD codes) and sex-, race-, age-, and center-matched euglycemic individuals (1:1) from the UK Biobank. Isolation and loneliness were measured using validated 3-item scales. We used Cox regression to examine the association between social isolation, loneliness and stroke risk (ICD codes for ischemic and hemorrhagic strokes) in the DM and euglycemic groups separately, adjusting for common cardiovascular risk factors and psychosocial comorbidities. We tested for sex differences by adding a sex-exposure interaction to the models and estimated the stroke absolute risk reduction (ARR) associated with improved isolation and loneliness.Results: During a median follow-up of 10 years, low social isolation and low loneliness (score=0 vs. score≥2) were associated with a reduced risk of stroke (isolation 0.83, 0.72-0.97; loneliness 0.73, 0.62-0.86) in the DM group, especially in men with DM (men isolation 0.79, 0.65-0.95, women 0.93, 0.72-1.22, p-interaction=0.05; loneliness men 0.63, 0.52-0.77, women, 0.96, 0.72-1.29, p-interaction=0.02). ARR associated with improved isolation and loneliness was 0.7% and 1.3% (equivalent to 7 and 13 stroke cases per 1000 people with DM, respectively, during the 10-year period). The association between isolation, loneliness and stroke risk was not significant in the euglycemic group.Conclusion: Improved social isolation and loneliness attenuate excess stroke risk in individuals with DM, particularly in men with DM.
X. Wu: None. Y. Zu: None. X. Wang: None. Y. Yoshida: None.
the National Institute of GeneralMedical Sciences of the National Institutes of Health (1P20GM152305)
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