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Bidirectional associations between loneliness and physical multimorbidity and the mediating role of social inactivity

Year: 2026
Type: article
Abstract: Physical multimorbidity and loneliness are increasingly recognised as public health concerns, but the nature of their potential relationships remains unclear. Here we report bidirectional associations between physical multimorbidity and loneliness in middle-aged and older adults and the mediating role of social inactivity. Longitudinal data from adults aged ≥45 years are analysed across 19 countries from five prospective cohorts: US Health and Retirement Study; English Longitudinal Study on Ageing; Survey of Health, Ageing and Retirement in Europe; China Health and Retirement Longitudinal Study; and Korean Longitudinal Study of Aging. Cox regression models suggest longitudinal associations between physical multimorbidity and loneliness in both directions (from physical multimorbidity to loneliness: adjusted hazard ratio (HR) = 1.25, 95% confidence interval (CI) = 1.20 to 1.30; from loneliness to physical multimorbidity: adjusted HR = 1.10, 95% CI = 1.05 to 1.17). Random-intercept cross-lagged panel models confirm significant association between T1 physical multimorbidity and T3 loneliness, with T2 social inactivity serving as a mediator. These findings suggest that physical multimorbidity and loneliness may create a vicious cycle where each condition exacerbates the other, with social inactivity mediating the direction from physical multimorbidity and loneliness.
DOI: 10.1038/s41467-026-76770-3
Institutions: Second Affiliated Hospital of Zhejiang University, Zhejiang University, Brigham Young University, University of Helsinki, University College London, The University of Queensland
Language: English
Subfield: Epidemiology
Field: Medicine
Open Access status: gold
Estimated APC paid: $6,990
Funders: Wellcome Trust, National Natural Science Foundation of China, Zhejiang University, National Institutes of Health, Medical Research Council, Fundamental Research Funds for the Central Universities
Awards: G1459383737, G1806953437, G2087418563, G2504750378, G2663055015, G3091909500, G3485977756, The Whitehall II study: A Core Resource for Ageing Research, G3816174250, Taking the long view: Identification of plasma protein biomarkers for dementia risk, G4642000788, Taking the long view: Identification of plasma protein biomarkers for dementia risk, G4944182283, G5727832949, G5813479750, G6985282239, G8086699232, G8337390295, G84288707, G9000219096
OpenAlex ID: W7203539691
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