{
  "abstract": "Background Loneliness and social isolation are increasingly recognised by the World Health Organisation as major determinants of poor health and wellbeing. Evidence also links them to higher healthcare use and costs, but little is known about their impact among people with chronic conditions or how costs evolve over time.Methods We conducted an incidence-based cost study from a healthcare perspective using data from the Clinical Record Interactive Search (CRIS), which contains anonymised electronic health records from a large mental health provider in South London. The sample included patients with comorbid type 2 diabetes (T2DM) and severe mental illness (SMI). Loneliness and living alone were identified using natural language processing algorithms applied to clinical notes. Data were linked to Hospital Episode Statistics (HES) for secondary care and Lambeth DataNet for primary care costs. Costs were calculated using a bottom-up approach, expressed in 2023/24 UK pounds, and censored at 20 years of follow-up. Total adjusted costs were estimated using a generalized linear mixed model with a Tweedie link. Longitudinal changes were analysed with piecewise regression, adjusting for demographic, clinical, and socioeconomic factors.Results The study included 996 patients (mean age 54.7±14.6 years); 36.2% were diagnosed with T2DM first. Mean follow-up was 8.0±5.1 years, and mortality was 31.5%. The prevalence of loneliness was 36.6% and living alone 57.5%. Adjusted total costs were £3,849 (95% CI: 1,872–7,381) for loneliness and £3,436 (1,711–6,947) for living alone. Loneliness was associated with higher secondary care costs (1.39, 95% CI: 1.04–1.86), while living alone predicted higher primary care costs (1.17, 1.04–1.33). Loneliness also predicted a faster increase in primary care costs over time (1.05, 1.03–1.06).Conclusion Poor social connectedness is associated with significantly higher healthcare costs in people with comorbid T2DM and SMI.",
  "authors": [
    {
      "affiliations": [
        "Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, London, UK"
      ],
      "name": "Dulce Alarcon-Yaquetto"
    },
    {
      "affiliations": [
        "Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK"
      ],
      "name": "Robert Stewart"
    },
    {
      "affiliations": [
        "Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, London, UK"
      ],
      "name": "James Shearer"
    }
  ],
  "title": "P11-1 Loneliness and living alone are associated with increased healthcare costs in patients with comorbid type 2 diabetes and severe mental illness: a longitudinal cost study",
  "uid": "2b12d1cf-c2fa-5820-8121-ae44a98a5f7d"
}