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Original Article Association of group-level segregation with cardiovascular health in older adults: an analysis of data from the Korean Social Life, Health, and Aging Project
Sung-Ha Lee1orcid , Hyeok-Hee Lee2,3orcid , Kiho Sung4orcid , Yoosik Youm4orcid , Hyeon Chang Kim2,3orcid
Epidemiol Health 2023;45e2023041-0
DOI: https://doi.org/10.4178/epih.e2023041
Published online: April 4, 2023
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1Center for Happiness Studies, Seoul National University, Seoul, Korea
2Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
4Department of Sociology, Yonsei University, Seoul, Korea
Corresponding author:  Yoosik Youm,
Email: yoosik@yonsei.ac.kr
Hyeon Chang Kim,
Email: hckim@yuhs.ac
Received: 27 October 2022   • Accepted: 20 March 2023
Sung-Ha Lee and Hyeok-Hee Lee contributed equally to this study as co-first authors.
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Abstract

OBJECTIVES
The adverse health effects of individual-level social isolation (e.g., perceived loneliness) have been well documented in older adults. However, little is known about the impact of collective-level social isolation on health outcomes. We sought to examine the association of group-level segregation with cardiovascular health (CVH) in older adults.
METHODS
From the prospective Korean Social Life, Health, and Aging Project database, we identified 528 community-dwelling older adults who were aged ≥60 years or were married to those aged ≥60 years. Participants who belonged to smaller social groups separate from the major social group were defined as group-level-segregated. The CVH score was calculated as the number of ideal non-dietary CVH metrics (0-6), as modified from the American Heart Association’s Life’s Simple 7. Using ordinal logistic regression models, we assessed cross-sectional and longitudinal associations between group-level segregation and CVH.
RESULTS
Of the 528 participants (mean age, 71.7 years; 60.0% female), 108 (20.5%) were segregated at baseline. In the crosssectional analysis, group-level segregation was significantly associated with lower odds of having a higher CVH score at baseline after adjusting for socio-demographic factors and cognitive function (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.43 to 0.95). Among 274 participants who completed an 8-year follow-up, group-level segregation at baseline was marginally associated with lower odds of having a higher CVH score at 8 years (OR, 0.49; 95% CI, 0.24 to 1.02).
CONCLUSIONS
Group-level segregation was associated with worse CVH. These findings imply that the social network structure of a community may influence its members’ health status.

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