Social disconnectedness, economic outcomes, and the role of pre-existing mental health conditions: A population-based cohort study

Despite the growing recognition of social disconnectedness as a critical public health issue, significant gaps in the existing evidence remain regarding its associated economic outcomes. This study aimed to examine differences in economic outcomes according to social disconnectedness and explore variation based on sex, age, and pre-existing mental health conditions. We conducted a cohort study linking data on social disconnectedness (loneliness, social isolation, low social support, and a composite measure) from the Danish National Health Survey in 2013 and 2017 (n = 158,970) with register data on economic outcomes (healthcare costs, wage income, and transfer payments) in the following calendar year. We used linear regression to estimate mean differences including sex- and age-stratified analyses and an analysis of interaction with pre-existing mental health conditions. Individuals who were socially disconnected had on average annual excess healthcare costs of €561 to €1,674, lower wage income of €7,207 to €16,295, and excess transfer payments of €2,845 to €8,977. When extrapolated, excess healthcare costs and transfer payments associated with the composite measure corresponded to 7.1% of all transfer payments and 9.0% of all healthcare costs. These economic differences varied according to sex and age and were greater among individuals with pre-existing mental health conditions. These findings can provide insights into economic disparities and may inform initiatives to optimize healthcare resource allocation and enhance workforce participation.