背景:不良的社会关系与卒中后死亡率之间的关系仍不确定,关于不良社会关系与卒中风险之间关系的证据不一致。在这个荟萃分析中,我们的目的是阐明在社会关系不良的个体中有关卒中风险和卒中后死亡率的证据,包括社会隔离,有限的社交网络,缺乏社会支持,和孤独。
方法:彻底搜索PubMed,Embase,和Cochrane图书馆数据库来系统地识别相关研究。数据提取由两名研究人员独立进行。使用随机效应或固定效应模型计算具有95%置信区间(CI)的集合比值比(OR)。进行了敏感性分析以评估结果的可靠性。进行随机效应荟萃回归以探索研究之间卒中风险估计的异质性来源。使用Egger和Begg测试对潜在发表偏倚进行评估。
结果:纳入19项研究,原产于全球4大洲和12个国家。共有1,675,707名参与者参与了这项荟萃分析。随机效应模型下的汇总分析显示,不良社会关系与卒中风险之间存在显着关联(OR=1.30;95CI:1.17-1.44),以及卒中后死亡率的风险增加(OR=1.36;95CI:1.07-1.73)。亚组分析显示了有限社交网络之间的关联(OR=1.52;95CI=1.04-2.21),孤独感(OR=1.31;95CI=1.13-1.51),缺乏社会支持(OR=1.66;95CI=1.04-2.63)与卒中风险有关。荟萃回归解释了研究之间报告的卒中风险差异的75.21%。随机效应荟萃回归结果表明,估计卒中风险的异质性可能源于纳入研究的大陆和发表年份。
结论:社会隔离,有限的社交网络,缺乏社会支持,孤独感已成为导致卒中后发病和随后死亡的独特危险因素。公共卫生政策必须优先考虑社会关系和孤独感在中风预防和中风后护理中的多方面影响。
背景:该协议于2024年5月1日在ProsperoInternationalProspectiveSystem上注册,注册号为CRD42024531036。
BACKGROUND: The association between poor social relationships and post-stroke mortality remains uncertain, and the evidence regarding the relationship between poor social relationships and the risk of stroke is inconsistent. In this meta-analysis, we aim to elucidate the evidence concerning the risk of stroke and post-stroke mortality among individuals experiencing a poor social relationships, including social isolation, limited social networks, lack of social support, and loneliness.
METHODS: A thorough search of PubMed, Embase, and the Cochrane Library databases to systematically identify pertinent studies. Data extraction was independently performed by two researchers. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either a random-effects or fixed-effects model. Sensitivity analyses were conducted to evaluate the reliability of the results. Random-effects meta-regression was performed to explore the sources of heterogeneity in stroke risk estimates between studies. Assessment for potential publication bias was carried out using Egger\'s and Begg\'s tests.
RESULTS: Nineteen studies were included, originating from 4 continents and 12 countries worldwide. A total of 1,675,707 participants contributed to this meta-analysis. Pooled analyses under the random effect model revealed a significant association between poor social relationships and the risk of stroke (OR = 1.30; 95%CI: 1.17-1.44), as well as increased risks for post-stroke mortality (OR = 1.36; 95%CI: 1.07-1.73). Subgroup analyses demonstrated associations between limited social network (OR = 1.52; 95%CI = 1.04-2.21), loneliness (OR = 1.31; 95%CI = 1.13-1.51), and lack of social support (OR = 1.66; 95%CI = 1.04-2.63) with stroke risk. The meta-regression explained 75.21% of the differences in reported stroke risk between studies. Random-effect meta-regression results indicate that the heterogeneity in the estimated risk of stroke may originate from the continent and publication year of the included studies.
CONCLUSIONS: Social isolation, limited social networks, lack of social support, and feelings of loneliness have emerged as distinct risk factors contributing to both the onset and subsequent mortality following a stroke. It is imperative for public health policies to prioritize the multifaceted influence of social relationships and loneliness in stroke prevention and post-stroke care.
BACKGROUND: The protocol was registered on May 1, 2024, on the Prospero International Prospective System with registration number CRD42024531036.