Gender-Specific Population Attributable Fractions for Cardiovascular Disease and All-Cause Mortality Associated with Living Arrangement in Community-Dwelling Older People

Abstract

Background: Living alone poses significant cardiovascular disease (CVD) and mortality risks. The population attributable fraction (PAF) quantifies the proportion of disease burden attributable to a specific risk factor. This study aims to estimate the PAF for CVD and all-cause mortality related to living completely alone. Additionally, the study examined the PAFs associated with not living with a partner/spouse. Methods: This study used longitudinal data from the Aspirin in Reducing Events in the Elderly (ASPREE) study and its sub-study, the ASPREE Longitudinal Study of Older Persons (ALSOP), which included 5853 men and 6998 women. The participants were community-dwelling healthy adults aged 70 + years without CVD, dementia, or significant physical disabilities. Adjusting for social determinants and traditional risk factors, the gender-specific PAFs of CVD and all-cause mortality attributable to living completely alone and not living with a partner/spouse were determined. Results: Among women, 13.5% (95% CI: 6.3%, 22.4%) of CVD events could be attributed to living completely alone, and 14.1% (95% CI: 4.6%, 25.2%) to not living with a partner/spouse. For all-cause mortality in women, the corresponding PAFs were 9.8% (95% CI: 3.7%, 16.6%) and 12.3% (95% CI: 5.8%, 20.8%), respectively. In contrast, among men, only the PAF between not living with a partner/spouse and all-cause mortality reached statistical significance (PAF = 6.0%; 95% CI: 1.7%, 10.2%). The remaining PAF estimates for CVD events and all-cause mortality were not statistically significant. Conclusion: The observed gender differences in CVD and all-cause mortality related to living alone highlight the need for tailored public health interventions to meet gender-specific needs for social connectedness.