Intersectional inequalities in loneliness across 28 European Countries: A longitudinal MAIHDA

Background

Loneliness is a public health concern associated with e.g. increased mortality and cardiovascular disease. While individual risk factors are well established, less is known about how intersectional inequalities and healthcare system capacity shape loneliness. Thus, we analysed loneliness trajectories across life span in Europe.

Methods

We analysed five SHARE waves (2013-2022), comprising 235,448 observations from 105,714 individuals aged 50+ across 28 countries, using the 3-item UCLA Loneliness Scale. We applied 4-level longitudinal Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAHIDA), nesting occasions within persons, within intersectional strata (sex, generation, migration background), and within countries. Variance partition coefficients (VPC), proportional change in variance (PCV), and random slopes for age were estimated. GDP and physician-to-population ratio were included as macro-level predictors.

Results

Mean age was 68 years (SD:9 years), 56.2% were female. Mean loneliness was 3.9 (SD:1.4; Range:3-9) across waves. PCV indicated that 60.1% variance was explained by the fixed effects of the strata defining variables, with VPC=2.2% of variance attributable to multiplicative intersectional effects. Random slopes showed increases among the Silent Generation (born ≥1945) compared to Baby Boomers (1946-1963) (β=-0.04, p<.001) and Generation X (1964-1979) (β=-0.05, p<.001), with women (β = 0.24, p<.001) and individuals with migration background (β = 0.08, p=.011) reporting higher loneliness. Higher physician-to-population ratio was associated with lower loneliness (β=-0.15, p<.001), with mitigating effects in lower-GDP countries (β = 0.05, p=.020).

Conclusions

Intersectional inequalities in loneliness accumulate with age, particularly among older women of the Silent Generation. Healthcare capacity moderates these disparities, pointing to opportunities for policy actions and highlighting the psychosocial role of physicians.

Key messages

• Loneliness gaps accumulate across the life course, with intersectional relationships accounting for 2.2% of loneliness variation across 28 European countries.

• Higher physician-to population ratio can mitigate loneliness, most strongly in lower-income countries, highlighting the role of physicians in addressing loneliness.