Loneliness and Cognitive Decline Among U.S. Adults: A Stratified Analysis of the BRFSS
1
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, United States
2
Department of Public Health, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
3
The Clive O. Callender Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, United States
4
Department of Medicine, Howard University College of Medicine, Washington, United States
5
Department of Public Health, Ekiti State Government, Ado-Ekiti, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A2412
ABSTRACT
BACKGROUND:
Loneliness is an emerging public health concern linked to adverse mental and physical outcomes. Its association with cognitive decline at the population level and across demographic groups remains understudied. We evaluated how the frequency of loneliness relates to subjective cognitive decline (SCD) in U.S. adults and whether associations differ by sex, age and race/ethnicity.
METHODS:
We performed a cross‑sectional analysis of adults aged ≥16 years using nationally representative 2016–2023 Behavioral Risk Factor Surveillance System data. Loneliness was categorized as never, rarely, sometimes, usually or always. The primary outcome was self‑reported SCD in the past year. Survey‑weighted logistic regression models adjusted for sociodemographic factors, health insurance, metropolitan status and survey year were used to estimate adjusted marginal probabilities of SCD across loneliness categories. Interaction terms and stratified margins evaluated effect modification by sex, age group (16–44, 45–64 and ≥65 years) and race/ethnicity (non‑Hispanic White, non‑Hispanic Black and Hispanic).
RESULTS:
Among 85,969 adults who reported loneliness, 13,879 (16.2%) experienced subjective cognitive decline (SCD), with a mean age of 65.7 ± 10.6 years. Loneliness showed a strong dose–response relationship with SCD. Predicted probabilities of SCD increased from 9.9 % (95 % CI, 9.3–10.5 %) among respondents who never felt lonely to 15.0 % (14.1–15.9 %) for rarely, 24.9 % (23.6–26.1 %) for sometimes, 38.4 % (34.4–42.5 %) for usually and 45.7 % (41.0–50.4 %) for always lonely adults (p < 0.001). Women who were always lonely had an adjusted probability of SCD that was 10.7 percentage points higher than men; sex differences were negligible at lower loneliness levels.
CONCLUSIONS:
Loneliness is independently and strongly associated with higher likelihood of subjective cognitive decline among U.S. adults, and this relationship is most pronounced for chronic loneliness. While sex and age modified the effect of loneliness, racial/ethnic disparities were minimal.
Loneliness is an emerging public health concern linked to adverse mental and physical outcomes. Its association with cognitive decline at the population level and across demographic groups remains understudied. We evaluated how the frequency of loneliness relates to subjective cognitive decline (SCD) in U.S. adults and whether associations differ by sex, age and race/ethnicity.
METHODS:
We performed a cross‑sectional analysis of adults aged ≥16 years using nationally representative 2016–2023 Behavioral Risk Factor Surveillance System data. Loneliness was categorized as never, rarely, sometimes, usually or always. The primary outcome was self‑reported SCD in the past year. Survey‑weighted logistic regression models adjusted for sociodemographic factors, health insurance, metropolitan status and survey year were used to estimate adjusted marginal probabilities of SCD across loneliness categories. Interaction terms and stratified margins evaluated effect modification by sex, age group (16–44, 45–64 and ≥65 years) and race/ethnicity (non‑Hispanic White, non‑Hispanic Black and Hispanic).
RESULTS:
Among 85,969 adults who reported loneliness, 13,879 (16.2%) experienced subjective cognitive decline (SCD), with a mean age of 65.7 ± 10.6 years. Loneliness showed a strong dose–response relationship with SCD. Predicted probabilities of SCD increased from 9.9 % (95 % CI, 9.3–10.5 %) among respondents who never felt lonely to 15.0 % (14.1–15.9 %) for rarely, 24.9 % (23.6–26.1 %) for sometimes, 38.4 % (34.4–42.5 %) for usually and 45.7 % (41.0–50.4 %) for always lonely adults (p < 0.001). Women who were always lonely had an adjusted probability of SCD that was 10.7 percentage points higher than men; sex differences were negligible at lower loneliness levels.
CONCLUSIONS:
Loneliness is independently and strongly associated with higher likelihood of subjective cognitive decline among U.S. adults, and this relationship is most pronounced for chronic loneliness. While sex and age modified the effect of loneliness, racial/ethnic disparities were minimal.
| eISSN: | 2654-1459 |
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