Loneliness and Healthcare Use in Older Adults: Evidence From a Nationally Representative Cohort in Northern Ireland—A Cross-Sectional Replication Study

Annette Burns, Gerard Leavey, Roger O'Sullivan

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Background: Few have explored associations between loneliness and healthcare use independent of health and health behaviors. Recent indication of gender effects also requires validation across health service and cultural settings. We investigated the associations among loneliness, health and healthcare use (HCU) in older adults including stratification to investigate whether associations differed by gender. Methods: Secondary analysis of a nationally representative sample of 8,309 community-dwelling adults aged 50 and over from the Northern Ireland Cohort for the Longitudinal Study of Aging. Primary outcomes were: self-reported General Practice (GP) and emergency department (ED) visits in past year. Negative binomial and logistic regression analysis were used to investigate associations between loneliness and HCU, later adjusting for potential confounders (health and health behaviors). Results: Loneliness was consistently positively associated with both GP and ED visits (with IRRs ranging from 1.10 to 1.49 for GP visits, 1.16 to 1.98 for ED visits and ORs ranging from 1.13 to 1.51 for reporting at least one ED visit). With addition of health and health behaviors, all associations between loneliness and HCU became non-significant, excepting a small independent association between UCLA score and GP visits [IRR 1.03 (95% CI 1.01–1.05)]. Stratification of models revealed no gender effects. Conclusion: All but one association between loneliness and HCU became non-significant when health and health behaviors were included. The remaining association was small but implications remain for health service resources at population level. No gender effects were present in contrast to recent findings in the Republic of Ireland. Further studies on gender, loneliness and healthcare use needed.
Original languageEnglish
Article number620264
Pages (from-to)1-8
Number of pages8
JournalFrontiers in public health
Early online date5 May 2021
Publication statusPublished online - 5 May 2021

Bibliographical note

Funding Information:
This secondary analysis paper forms part of a joint programme of research which was funded by the Institute of Public Health in Ireland (IPH) and the Bamford Centre for Mental Health and Wellbeing, Ulster University.

Funding Information:
We are grateful to all the participants of the NICOLA Study, and the whole NICOLA team, which includes nursing staff, research scientists, clerical staff, computer and laboratory technicians, managers, and receptionists. The Atlantic Philanthropies, the Economic and Social Research Council, the UKCRC Centre of Excellence for Public Health Northern Ireland, the Centre for Aging Research and Development in Ireland, the Office of the First Minister and Deputy First Minister, the Health and Social Care Research and Development Division of the Public Health Agency, the Wellcome Trust/Wolfson Foundation and Queen’s University Belfast provide core financial support for NICOLA. A special thanks to Dr. Charlotte Neville (Scientific Officer at the Northern Ireland Cohort for the Longitudinal Study of Aging) for her assistance on remote data enquiries and guidance on data cleaning enquiries as well as Mrs. Angie Scott (Data manager at The Northern Ireland Cohort for the Longitudinal Study of Aging) for her administrative assistance throughout the study. The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the authors and do not necessarily represent those of the NICOLA Study team.

Publisher Copyright:
© Copyright © 2021 Burns, Leavey and O'Sullivan.

Copyright © 2021 Burns, Leavey and O'Sullivan.


  • Public Health
  • loneliness
  • healthcare use
  • emergency department
  • general practice
  • older adults
  • Primary care (MeSH)
  • Cross-Sectional Studies
  • Humans
  • Middle Aged
  • Delivery of Health Care
  • Loneliness
  • Aged
  • Longitudinal Studies
  • Northern Ireland/epidemiology


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