Does Loneliness Have a Cost? A Population-Wide Study of the Association Between Loneliness and Healthcare Expenditure

Abstract

Objectives: Loneliness has been associated with unhealthy behavior, poorer health, and increased morbidity. However, the costs of loneliness are poorly understood.Methods: Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (18+). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e., demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for four age groups.Results: Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5 and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19–40, the contribution of loneliness represented 61.8% of the overall association).Conclusion: Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.

Regional differences in healthcare costs further explained: The contribution of health, lifestyle, loneliness and mastery

“…As a result, we could only analyze associations and were unable to draw any causal conclusions. We know that an unhealthy lifestyle and loneliness are related to healthcare costs [6][7][8][9]. However, we do not know whether lifestyle and loneliness lead to poor health and thereby to higher healthcare costs, nor whether poor health leads to (more) loneliness and an unhealthy lifestyle.…”

“…In these healthcare cost studies, a part of the Dutch population was assessed, adjusted for age and gender [ 3 , 4 ], socioeconomic status (SES), and self-reported health [ 4 ]. In addition to demographic characteristics, SES, and self-reported health [ 5 ], there are other factors that appear to play a role in higher healthcare utilization and, as a result, higher costs, such as an unhealthy lifestyle [ 6 , 7 ] and loneliness [ 8 , 9 ]. Lonely citizens visit a doctor more often [ 8 , 9 ], are more frequently in need of mental healthcare [ 8 ] and inpatient care, and are more likely to take antidepressants and anxiolytics [ 9 ].…”

On social health: Conceptualization, Correlates and Patterning

“…For example, one study of the cost of illness (Fulton & Jupp, 2015) estimated that chronic loneliness costs an average of £11,725 (equivalent to approximately $16,000) per person over a medium term (i.e., 15 years), including a variety of both medical (e.g., in-patient costs) and non-medical costs (e.g., costs of residential care). Similarly, estimates from a nationally representative sample in the Netherlands (Meisters et al, 2021) suggest that loneliness cost €3,462,000,000 (equivalent to approximately $4,200,000,000) in healthcare expenditure in 2017. Generally, such estimates are conservative in that they cannot incorporate all of the various ways in which poor social health impairs life trajectories (e.g., worse educational and career prospects, lack of benefits and security related to marriage and family), yet the enormous costs to society are still readily apparent.…”

Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health?

“…The response rate for the Health Survey was 40% in 2016 [30], with a total of 445,748 complete responses. These data have been previously used to, for example, study the association of loneliness and healthcare costs in a nationally representative sample [26]. For more information regarding the content and distribution method of the Health Survey, we refer to [29].…”

“…Studies have shown that loneliness is correlated with mortality [ 12 , 21 ], as well as poorer physical [ 12 , 22 ] and mental health [ 12 , 23 ]. Lonely people were also more likely to engage in unhealthy behaviors [ 24 , 25 ] and visit physicians [ 25 , 26 ] and mental healthcare providers [ 26 ] more frequently. Although loneliness is closely interlinked with other known determinants of health [ 25 ], to date the extent of its contribution to socioeconomic health inequalities in the general population remains unclear.…”