title: A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA.
abstract: OBJECTIVE
  Previous studies have established a relationship between low levels of social networks and total mortality, but few have examined cause specific mortality or disease incidence. This study aimed to examine prospectively the relationships between social networks and total and cause specific mortality, as well as cardiovascular disease incidence.
  
  
  METHODS
  This was a four year follow up study in an ongoing cohort of men, for whom information on social networks was collected at baseline. The main outcome measures were total mortality, further categorised into deaths from cardiovascular disease (stroke and coronary heart disease), total cancer, accidents/suicides, and all other causes; as well as stroke and coronary heart disease incidence.
  
  
  METHODS
  Altogether 32,624 US male health professionals aged 42 to 77 years in 1988, who were free of coronary heart disease, stroke, and cancer at baseline.
  
  
  RESULTS
  A total of 511 deaths occurred during 122,911 person years of follow up. Compared with men with the highest level of social networks, socially isolated men (not married, fewer than six friends or relatives, no membership in church or community groups) were at increased risk for cardiovascular disease mortality (age adjusted relative risk, 1.90; 95% CI 1.07, 3.37) and deaths from accidents and suicides (age adjusted relative risk 2.22; 95% CI 0.76, 6.47). No excess risks were found for other causes of death. Socially isolated men were also at increased risk of stroke incidence (relative risk, 2.21; 95% CI, 1.12, 4.35), but not incidence of non-fatal myocardial infarction.
  
  
  CONCLUSIONS
  Social networks were associated with lower total mortality by reducing deaths from cardiovascular disease and accidents/suicides. Strong social networks were associated with reduced incidence of stroke, though not of coronary heart disease. However, social networks may assist in prolonging the survival of men with established coronary heart disease.
authors.affiliation: Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: I
authors.initials: I
authors.lastname: Kawachi
authors.forename: G A
authors.initials: GA
authors.lastname: Colditz
authors.forename: A
authors.initials: A
authors.lastname: Ascherio
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.forename: E
authors.initials: E
authors.lastname: Giovannucci
authors.forename: M J
authors.initials: MJ
authors.lastname: Stampfer
authors.forename: W C
authors.initials: WC
authors.lastname: Willett
mesh_terms: D000059:Accidents / Q000401:mortality; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000401:mortality; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D012944:Social Support; D013405:Suicide; D014481:United States / Q000453:epidemiology