Social Cohesion and Disease Burden in Rhode Island

Background and Objectives: Social epidemiology is interested in how human networks influence the health status of populations. Social cohesion (SC) in adults has been defined as a 3-pronged construct that includes social network access, civic participation, and community trust. This study explores the relationship between SC and disease burden (DB) with data from the Rhode Island 2005 Behavioral Risk Factor Surveillance System (BRFSS).

Methods: Medical conditions and social risks were grouped in interval scales: nine levels for respondents with 0-8 conditions and 10 levels for respondents with 0-9 social risks. DB and SC were converted into four-point (0, 1, 2, and 3+ diagnoses/0, 1, 2, and 3+ social risks) ordinal variables. Simple and multiple logistic regression analysis tested for differences between low (0-2) and high (3+) DB.

Results: In 2005, 155,000 (18%) adults reported a DB of >3 (DB3+), and 209,000 (27%) >3 SC risks (SR3+). 32% (47,186) with DB3+ reported >3. SC variables ranged from neighborhood dissatisfaction (6%) to “feels cannot make a difference in his/her community” (41%). Unadjusted ORs were very significant for SR2+ (1.4; 1.3), SR3+ (1.4) and SR4+ (1.4). For adjusted ORs, associations were very and highly significant for life satisfaction (1.4) and age (1.5).

Conclusions: DB3+ respondents were more likely than those with lower DB to report higher SR levels. After adjusting for demographic and psychosocial variables, ORs increased as SRs increased. Findings support SC surveillance, investment on initiatives to strengthen individual/community networks, and research on the health service implications of SR and DB.