Social Isolation and Hypertension Among Older African Americans: Are There Gender Differences?

Background and Purpose: Social isolation is associated with many negative health outcomes, including hypertension and mortality. Hypertension is a major health concern for older African Americans with three out of four individuals likely to develop the condition by age of 55. Although many studies have documented the detrimental effects of social isolation on health, few have explored how the social isolation-health connection may vary between genders. To address these gaps in empirical knowledge, the aim of this study is to determine whether the association between social isolation and hypertension varies by gender among older African Americans.  This investigation examines objective (i.e., a paucity of social contact with members of your social network) and subjective (i.e., not feeling particularly close to members of one’s social network) social isolation from family and friends in relation to hypertension among a nationally representative sample of African Americans.

Methods:This study uses the National Survey of American Life (NSAL) dataset, a nationally representative study of African Americans, Black Caribbeans, and Whites living in the United States. This analytic sample consists of 837 African Americans age 55 and older. Objective isolation was operationalized in four categories: 1) isolated from both family and friends, 2) isolated from family only, 3) isolated from friends only, and 4) not isolated from either family or friends. Subjective isolation was operationalized in the same manner. Additional covariates included age, educational attainment, family income, marital status, region, physical activity, body mass index (BMI), and negative interactions with family members. Two logistic regression models were used to test gender differences in the impact of objective and subjective social isolation on hypertension.

Results: In general, objective isolation rates were slightly higher than subjective isolation rates. We found among individuals who were subjectively isolated from both family and friends, men were substantially more likely to be diagnosed with hypertension than women; however, men and women who were not subjectively isolated from family or friends had similar probabilities for hypertension. Additionally, men who were subjectively isolated from both family and friends had a higher probability of hypertension than men who were not subjectively isolated from either group. Lastly, women who were subjectively isolated from both family and friends had a lower probability of hypertension than women who were not subjectively isolated from either group.

Conclusions and Implications: The data revealed that subjective isolation is more detrimental to the health of older African American men than women. Additionally, for older African American women, subjective isolation had an inverse effect on hypertension. These findings indicate that social relationships function differently for men and women, with men receiving greater health benefits from their close relationships than women. These findings suggest that the qualitative assessments of social isolation is critical and perhaps even more important than objective assessments of isolation in older African Americans.  This study contributes to the Grand Challenge of “Eradicating Social Isolation” and the call for increased cultural competence in social work practice with populations of color.