Social Network, Social Support, and Risk of Incident Stroke

Abstract

Background and Purpose Having a small social network and lack of social support have been associated with incident coronary heart disease, however epidemiologic evidence for incident stroke is limited. We assessed the longitudinal association of a small social network and lack of social support with risk of incident stroke, and evaluated whether the association was partly mediated by vital exhaustion and inflammation. Methods The Atherosclerosis Risk in Communities (ARIC) Study measured social network and social support in 13,686 men and women (mean, 57±5.7 years, 56% female, 24% black; 76% white) without a history of stroke. Social network was assessed by the 10-item Lubben Social Network Scale, and social support by a 16-item Interpersonal Support Evaluation List-Short Form (ISEL-SF). Results Over a median follow-up of 18.6-years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke [HR (95% CI): 1.44 (1.02–2.04)] after adjustment for demographics, socioeconomic variables and marital status, behavioral risk factors and major stroke risk factors. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and incident stroke. Social support was unrelated to incident stroke. Conclusions In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network may be associated with a modestly increased risk of incident stroke.

Social Network and Stroke Risk

“…This result incorporates adjustment for the higher likelihood of being black, male, unmarried, unemployed, less educated, diabetic, a smoker, and scoring highly on the vital exhaustion measure among the 380 participants (2.8%) with a small social network compared with a large social network. 16 The association appeared to be partly mediated by perceived social support and vital exhaustion (fatigue, irritability, and feelings of demoralization) but not inflammation (high-sensitivity C-reactive protein). There was no significant increase in the incidence of stroke among the few participants (0.5%) who perceived a lack of social support compared with those with high social support (HR, 1.59; 95% CI, 0.75-3.36).…”

“…There was no significant increase in the incidence of stroke among the few participants (0.5%) who perceived a lack of social support compared with those with high social support (HR, 1.59; 95% CI, 0.75-3.36). 16 The internal validity of the ARIC study results is supported by the rigorous study methodology. A large cohort (n=13 686) of community-dwelling, biracial, middle-aged, stroke-free men and women were recruited prospectively from sampling 4 US communities and underwent a standardized baseline assessment of candidate variables (social network by the 10-item Lubben Social Network Scale, and perceived social support by a 16-item Interpersonal Support Evaluation List-Short Form) and covariates.…”

“…15 Having no friends (adjusted HR, 0.98; 95% CI, 0.80-1.20) and no esteem support (adjusted HR, 1.16; 95% CI, 0.99-1.37) were not associated with a higher incidence of stroke, however; nor was low social support (HR, 1.11; 95% CI, 0.89-1.37). 15 In this issue of Stroke, Nagayoshi et al 16 report that a small social network was associated with a 44% increased risk of stroke (HR, 1.44; 95% CI, 1.02-2.04) compared with a large social network in the Atherosclerosis Risk in Communities (ARIC) study. This result incorporates adjustment for the higher likelihood of being black, male, unmarried, unemployed, less educated, diabetic, a smoker, and scoring highly on the vital exhaustion measure among the 380 participants (2.8%) with a small social network compared with a large social network.…”

“…A large cohort (n=13 686) of community-dwelling, biracial, middle-aged, stroke-free men and women were recruited prospectively from sampling 4 US communities and underwent a standardized baseline assessment of candidate variables (social network by the 10-item Lubben Social Network Scale, and perceived social support by a 16-item Interpersonal Support Evaluation List-Short Form) and covariates. 16 After a median of 18.6 years follow-up, a large number (n=905) of incident stroke outcomes were adjudicated according to a standardized definition of stroke. The limitations of the study include measurement of social network and support based on self-report and at one point in time only, probable incomplete ascertainment of stroke outcome events (hospitalized or fatal strokes reported by participants and proxys), and limited statistical power to evaluate the effect of a perceived lack of social support on stroke risk because of its low prevalence (0.5%) in the study population.…”

“…6,14,15 The results of the first study of 2603 health maintenance organization members 5 may also have been consistent if the authors of that study had not defined a small social network as a score in the lowest tertile, because this may have been too crude a subcategorization if the prevalence of a small social network was well below one third, as observed in the ARIC study. 16 Overall, the totality of published evidence suggests that a small social network is a risk factor for incident stroke. The association is reasonably strong, consistent, specific, and plausible.…”