The impact of social relationships on the risk of stroke and post-stroke mortality: a systematic review and meta-analysis

Abstract

Abstract Background The association between poor social relationships and post-stroke mortality remains uncertain, and the evidence regarding the relationship between poor social relationships and the risk of stroke is inconsistent. In this meta-analysis, we aim to elucidate the evidence concerning the risk of stroke and post-stroke mortality among individuals experiencing a poor social relationships, including social isolation, limited social networks, lack of social support, and loneliness. Methods A thorough search of PubMed, Embase, and the Cochrane Library databases to systematically identify pertinent studies. Data extraction was independently performed by two researchers. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either a random-effects or fixed-effects model. Sensitivity analyses were conducted to evaluate the reliability of the results. Random-effects meta-regression was performed to explore the sources of heterogeneity in stroke risk estimates between studies. Assessment for potential publication bias was carried out using Egger’s and Begg’s tests. Results Nineteen studies were included, originating from 4 continents and 12 countries worldwide. A total of 1,675,707 participants contributed to this meta-analysis. Pooled analyses under the random effect model revealed a significant association between poor social relationships and the risk of stroke (OR = 1.30; 95%CI: 1.17–1.44), as well as increased risks for post-stroke mortality (OR = 1.36; 95%CI: 1.07–1.73). Subgroup analyses demonstrated associations between limited social network (OR = 1.52; 95%CI = 1.04–2.21), loneliness (OR = 1.31; 95%CI = 1.13–1.51), and lack of social support (OR = 1.66; 95%CI = 1.04–2.63) with stroke risk. The meta-regression explained 75.21% of the differences in reported stroke risk between studies. Random-effect meta-regression results indicate that the heterogeneity in the estimated risk of stroke may originate from the continent and publication year of the included studies. Conclusion Social isolation, limited social networks, lack of social support, and feelings of loneliness have emerged as distinct risk factors contributing to both the onset and subsequent mortality following a stroke. It is imperative for public health policies to prioritize the multifaceted influence of social relationships and loneliness in stroke prevention and post-stroke care. Trial registration The protocol was registered on May 1, 2024, on the Prospero International Prospective System with registration number CRD42024531036.

Keywords

• Social isolation
• Social network
• Social support
• Stroke
• Mortality
• Meta-analysis