Journal of Capital Medical University ›› 2026, Vol. 47 ›› Issue (4): 775-782.doi: 10.3969/j.issn.1006-7795.2026.04.018

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Association of loneliness with transition risks of major non-communicable chronic diseases and healthy life expectancy among middle-aged populations in China

Xia Xue1,2,3， Tian Xue1,2,3， Zhou Quan1,2,3， Xu Qin1,2,3， Zhang Yijun1,2,3， Zhang Xiaoli1,2,3， Li Jing1,2,3， Wang Anxin1,2,3*   

  1. 1.Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing  100070, China; 2.China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing  100070, China
  • Received:2025-11-08 Revised:2025-12-23 Online:2026-08-21 Published:2026-07-26
  • Supported by:
    This study was supported by the National Natural Science Foundation of China (82504498).

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Abstract: Objective  To explore the association between loneliness and the whole transition course of non-communicable chronic diseases (NCDs), and to quantify its impact on life expectancy (LE) and healthy life expectancy (HLE) among middle-aged population.Methods  Based on the 2011—2020 follow-up data of individuals aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS), a multi-state Markov model (MSM) was fitted to analyze the association of loneliness with the occurrence and progression of NCDs. Further, microsimulation was used to quantify its impact on both LE and HLE.Results  Of 12 316 participants included in the study, 47.99% were males and the median age was 59 （52，66） years-old. The transition course of NCDs mainly involved three pathways: from health to NCDs, from health to death, and from NCDs to death. During the follow-up period, 3 616 new cases of NCDs and 1 858 deaths were recorded. Compared with those who rarely felt lonely, healthy individuals with loneliness had a 20% increased risk of NCDs (OR＝1.20， 95%CI: 1.10－1.30) and a 38% increased risk of death (OR＝1.38， 95%CI: 1.15－1.66). Loneliness was significantly associated with an increased risk of transition from health to NCDs regardless of gender, whereas its impacts on transitions from health or NCDs to death seemed different between males and females (P forinteraction< 0.05). In addition, middle-aged individuals with loneliness had shorter LE, and the proportion of healthy survival time was also smaller. For individuals who were initially healthy, the HLE at the age of 45 years and its proportion was 12.8 years (32.8%) for lonely participants and 14.4 years (34.5%) for those without loneliness, respectively.Conclusion  Loneliness was significantly associated with increased risks of NCDs and death, which led to shortened LE and reduced proportion of HLE for middle-aged population.

Key words: loneliness, non-communicable chronic disease, multi-state Markov model, life expectancy, healthy life expectancy, cohort

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