UMMS Affiliation

Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Geriatrics | Mental and Social Health | Preventive Medicine | Psychiatry and Psychology | Social Psychology and Interaction | Women's Health



The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potential mediator and age and race and ethnicity as effect modifiers.

Methods and Results

This study included 44 174 postmenopausal women of diverse race and ethnicity from the WHI (Women's Health Initiative) study who underwent annual assessment for HF adjudication from baseline enrollment (1993-1998) through 2018. We conducted a mediation analysis to examine depressive symptoms as a potential mediator and further examined effect modification by age and race and ethnicity. Incident HF requiring hospitalization was the main outcome. Social isolation was a composite variable based on marital/partner status, religious ties, and community ties. Depressive symptoms were assessed using CES-D (Center for Epidemiology Studies-Depression). Over a median follow-up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08-1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07-1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF.


Socially isolated older women are at increased risk for developing HF, independent of traditional HF risk factors.


URL:; Unique identifier: NCT00000611.


heart failure, older adults, social isolation, women

Rights and Permissions

© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

DOI of Published Version



Cené CW, Leng XI, Faraz K, Allison M, Breathett K, Bird C, Coday M, Corbie-Smith G, Foraker R, Ijioma NN, Rosal MC, Sealy-Jefferson S, Shippee TP, Kroenke CH. Social Isolation and Incident Heart Failure Hospitalization in Older Women: Women's Health Initiative Study Findings. J Am Heart Assoc. 2022 Feb 22:e022907. doi: 10.1161/JAHA.120.022907. Epub ahead of print. PMID: 35189692. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Heart Association

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License