Social support and risk of mortality in cirrhosis: A cohort study

Askgaard, Gro; Madsen, Lone Galmstrup; von Wowern, Natasja; Winther-Jensen, Matilde; Lau, Cathrine Juel; Christensen, Anne Illemann; Crooks, Colin; West, Joe; Jepsen, Peter

Abstract

Background & Aims
The function and structure of social relationships influence mortality in individuals within the general population. We compared aspects of social relationships in patients with cirrhosis and a matched comparison cohort and studied their association with health-related quality of life (HRQoL) and mortality in cirrhosis.

Methods
Patients with cirrhosis and comparators were identified among participants of the Danish National Health Surveys 2010-2017. The surveys included questions on functional (social support and loneliness) and structural (living alone/cohabitating and frequency of contacts with relatives and friends) aspects of social relationships and HRQoL (Short-Form 12). We estimated associations of aspects of social relationships in cirrhosis patients
with HRQoL and all-cause mortality through 2020.

Results
Of 541 cirrhosis patients and 2,157 comparators, low social support (22% in cirrhosis vs 13% in comparators), loneliness (35% vs 20%), and living alone (48% vs 22%) were more frequent in cirrhosis than comparators, whereas the frequency of contacts with relatives and friends was similar. Except for living alone, weak functional and structural social relationships were associated with lower mental HRQoL in cirrhosis patients. Physical HRQoL was only marginally associated with social relationships. During 2,795 person-years of follow-up, 269 cirrhosis patients died. Functional and not structural aspects of social relationships were associated with risk of mortality in cirrhosis. Specifically, the adjusted hazard ratio was 1.4 (95% CI: 1.1-1.9), p = 0.011, for low vs moderate-to-high social support (functional aspect), and 1.0 (0.8-1.3), p = 0.85 for living alone vs cohabitating (structural aspect).

Conclusions
Patients with cirrhosis have weaker functional and structural social relationships than matched comparators. Weak functional relationships are associated with lower mental HRQoL and increased risk of mortality in cirrhosis.

Lay summary
This study investigated the prevalence of weak social relationships in cirrhosis and their influence on health-related quality of life and risk of mortality. Patients with cirrhosis were nearly twice as likely to report low social support, loneliness and to live alone than a matched comparison cohort. Low social support and loneliness were associated with lower mental health-related quality of life and increased risk of mortality risk in cirrhosis, when adjusting for known confounders.

• Journal Article Type: Article
• Acceptance Date: Sep 21, 2022
• Online Publication Date: Oct 3, 2022
• Publication Date: 2023-01
• Deposit Date: Oct 6, 2022
• Publicly Available Date: Oct 6, 2022
• Journal: JHEP Reports
• Electronic ISSN: 2589-5559
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 1
• Article Number: 100600
• DOI: https://doi.org/10.1016/j.jhepr.2022.100600
• Keywords: Gastroenterology; Hepatology; Immunology and Allergy; Internal Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/12031719
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2589555922001720?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Social support and risk of mortality in liver cirrhosis: A cohort study; Journal Title: JHEP Reports; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jhepr.2022.100600; Content Type: article; Copyright: © 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).