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

Background & Aims: The function and structure of social relationships influence mortality in individuals within the general
population. We compared aspects of social relationships in individuals with cirrhosis and a matched comparison cohort and
studied their association with health-related quality of life (HRQoL) and mortality in cirrhosis.
Methods: Individuals 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 with HRQoL and all-cause mortality in individuals with cirrhosis
through 2020.
Results: Of 541 individuals with cirrhosis 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 individuals with 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 those with cirrhosis. Physical HRQoL was only
marginally associated with social relationships. During 2,795 person-years of follow-up, 269 individuals with cirrhosis 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 (95% CI 0.8–1.3), p = 0.85 for living alone vs. cohabitating (structural aspect).
Conclusions: Individuals 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 individuals with
cirrhosis.
Impact and implications: This study investigated the prevalence of weak social relationships in individuals with cirrhosis
and their influence on health-related quality of life and risk of mortality. Individuals 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
(functional measures of social relationships) were associated with lower mental health-related quality of life and
increased risk of mortality risk in cirrhosis, when adjusting for known confounders. We hope that these results will make
healthcare providers aware of the functional aspects of the social relationships of individuals with cirrhosis, in addition to the
traditional clinical management, and motivate further research of interventions to strengthen the social support of individuals
with cirrhosis.