Background Living alone has been associated with increased mortality risk, but it is unclear whether this is a result of a selection effect or the impact of stressful life changes such as widowhood or divorce leading to changes in living arrangements. We therefore examined the association between living alone, transitions in living arrangements and all-cause mortality. Method We analysed data from 4,888 individuals who participated in both wave 2 (2004–2005) and wave 4 (2008–2009) of the English Longitudinal Study of Ageing. Transitions in living arrangements over this period were identified. Mortality status was ascertained from linked national mortality registers. Cox proportional hazards analysis was used to examine the association between living alone and mortality over an average 8.5 year follow-up period. Results An association was found between living alone at wave 4 and mortality (hazard ratio (HR): 1.20, 95% CI 1.04–1.38) in a model adjusted for multiple factors including socioeconomic status, physical health, health behaviours and loneliness. We also found that participants who moved to living alone after divorce or bereavement had a higher risk of mortality compared with those who lived with others at both time points (HR: 1.34, 95% CI 1.01–1.79), while those who moved to living alone for other reasons did not show an increased mortality risk. Conclusions The relationship between living alone and mortality is complicated by the reasons underlying not living with others. A greater understanding of these dynamics will help to identify the individuals who are at particular health risk because of their living arrangements.

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为什么老年人独居与死亡风险增加有关？纵向队列研究

背景 独居与死亡风险增加有关，但尚不清楚这是否是选择效应的结果，或者是压力性生活变化（如丧偶或离婚）导致生活安排变化的影响。因此，我们研究了独居、生活安排转变和全因死亡率之间的关系。方法 我们分析了参与英国老龄化纵向研究的第 2 波（2004-2005 年）和第 4 波（2008-2009 年）的 4,888 名个人的数据。确定了这一时期生活安排的转变。从相关的国家死亡率登记册确定死亡率状态。Cox 比例风险分析用于检查平均 8.5 年随访期间独居与死亡率之间的关联。结果 在针对包括社会经济地位、身体健康、健康行为和孤独感在内的多种因素进行调整的模型中，发现第 4 波独居与死亡率（风险比 (HR)：1.20，95% CI 1.04-1.38）之间存在关联。我们还发现，与在两个时间点与他人同住的人相比，离婚或丧亲后搬到独居的参与者的死亡风险更高（HR：1.34，95% CI 1.01-1.79），而那些搬到同居的人仅出于其他原因并没有显示出增加的死亡风险。结论 独居与死亡率之间的关系因不与他人生活的潜在原因而复杂化。对这些动态有更深入的了解将有助于识别因生活安排而面临特定健康风险的个人。