Social Isolation and Incidence of Chest Pain and Mortality in Older Adults of the United States Population: A Cross‐Sectional Study From NHANES 2001–2018

ABSTRACT Background Our study aimed to investigate the association between social isolation and chest pain, and to evaluate the relationship between social isolation and all‐cause mortality stratified by the presence or absence of chest pain among participants. Methods This study incorporated data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES) from the whole of the United States, adopting a hybrid design integrating cross‐sectional and longitudinal cohort methodologies. Weighted logistic regression modeling was employed to examine the association between social isolation and chest pain. Additionally, a weighted Cox proportional hazards model was utilized to estimate hazard ratio (HR) and 95% confidence interval (CI) for all‐cause mortality. Results Analysis revealed a notable association between social isolation scores and chest pain. Following covariate adjustment, individuals with social isolation scores of 3 or 4 exhibited a 52% higher likelihood of reporting chest pain compared to the reference category. Compared with the socially integrated group, the socially isolated group had an approximately 31% increased risk of chest pain. Multivariate Cox regression analysis showed that, after adjusting for all covariates, the risk‐adjusted ratio (HR) for death was 2.17 for participants with social isolation scores of 3 to 4 and 2.06 for those with chest pain. Compared with the socially integrated group, the risk‐adjusted ratio for death in the socially isolated group was 1.65 among all participants and 1.48 among those with chest pain and 2.43 in the group without chest pain. High social isolation was associated with an increased risk of death, regardless of the presence of chest pain. Conclusions Our findings demonstrate a significant association between social isolation and increased prevalence of chest pain, identifying specific high‐risk subgroups. Importantly, social isolation was linked to elevated all‐cause mortality in both individuals with and without chest pain, highlighting its independent prognostic significance across these clinical subgroups.