Differences in Social Isolation and Its Relationship to Health by Rurality

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PURPOSE: Social isolation is an urgent threat to public health. Meanwhile, health outcomes across multiple measures are worse in rural areas, where distance to neighbors is often greater and opportunities for social interaction may be scarcer. Still, very little research examines rural-urban differences in social isolation. This study addresses that gap by examining differences in social isolation by rurality among US older adults.

METHODS: Using Wave 2 of the National Social Life, Health, and Aging Project data (n = 2,439), we measured differences between urban and rural (micropolitan or noncore) residents across multiple dimensions of social isolation. We also conducted multivariable analysis to assess the associations between rurality, sociodemographic characteristics, and loneliness, overall and by rurality. Finally, we conducted multivariable analysis to assess the association between social isolation and self-rated health, adjusting for rurality.

FINDINGS: Compared to urban residents, rural residents had more social relationships and micropolitan rural residents were more likely to be able to rely on family members (95.8% vs 91.3%, P < .05). Micropolitan rural residents reported lower rates of loneliness than urban residents after adjusting for sociodemographic and health characteristics (b = -0.32, P < .05), whereas noncore rural, non-Hispanic black residents had a greater likelihood of reporting loneliness (b = 4.33, P < .001).

CONCLUSIONS: Overall, noncore and micropolitan rural residents reported less social isolation and more social relationships than urban residents. However, there were differences by race and ethnicity among rural residents in perceived loneliness. Policies and programs to address social isolation should be tailored by geography and should account for within-rural differences in risk factors.

Original languageEnglish (US)
Pages (from-to)540-549
Number of pages10
JournalJournal of Rural Health
Issue number4
StatePublished - Sep 1 2019

Bibliographical note

Funding Information:
This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS) under PHS Grant No. 5U1CRH03717. The information, conclusions and opinions expressed in this paper are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Publisher Copyright:
© 2019 National Rural Health Association


  • loneliness
  • older adults
  • social determinants of health
  • social isolation
  • social support

PubMed: MeSH publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Journal Article


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