In the Midst of a Pandemic, Introverts May Have a Mortality Advantage

  1. Dana A. Glei
  2. Maxine Weinstein

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Abstract

Extroverts may enjoy lower mortality than introverts under normal circumstances, but the relationship may be different during an airborne pandemic when social contact can be deadly. We used data for midlife Americans surveyed in 1995-96 with mortality follow-up through December 31, 2020 to investigate whether the association between extroversion and mortality changed during the COVID-19 pandemic. We hypothesized that excess mortality during the pandemic will be greater for extroverts than for introverts. Results were based on a Cox model estimating age-specific mortality controlling for sex, race/ethnicity, the period trend in mortality, and an additional indicator for the pandemic period (Mar-Dec 2020). We interacted extroversion with the pandemic indicator to test whether the relationship differed between prepandemic and pandemic periods. Prior to the pandemic, extroversion was associated with somewhat lower mortality (HR=0.93 per SD, 95% CI 0.88-0.97), but the relationship reversed during the pandemic: extroverted individuals appeared to suffer higher mortality than their introverted counterparts, although the effect was not significant (HR=1.20 per SD, 95% CI 0.93-1.54).

Extroversion was associated with greater pandemic-related excess mortality (HR=1.20/0.93=1.29 per SD, 95% CI 1.00-1.67). Compared with someone who scored at the mean level of extroversion, mortality rates prior to the pandemic were 10% lower for a person who was very extroverted (i.e., top 12% of the sample at Wave 1), while they were 12% higher for someone who was very introverted (i.e., 11 th percentile). In contrast, mortality rates during the pandemic appeared to be highe r for very extroverted individuals (HR=1.15, 95% CI 0.77-1.71) and l ower for those who were very introverted (HR=0.70, 95% CI 0.43-1.14) although the difference was not significant because of limited statistical power. In sum, the slight mortality advantage enjoyed by extroverts prior to the pandemic disappeared during the first 10 months of the COVID-19 pandemic. It remains to be seen whether that pattern continued into 2021-22. We suspect that the mortality benefit of introversion during the pandemic is largely a result of reduced exposure to the risk of infection, but it may also derive in part from the ability of introverts to adapt more easily to reduced social interaction without engaging in self-destructive behavior (e.g., drug and alcohol abuse). Introverts have been training for a pandemic their whole lives.

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    SciScore for 10.1101/2022.05.24.22275508: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

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    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: There are several limitations to this study, First, mortality during 2020 is almost certainly under-estimated. Deaths during 2020 were based on an early release file for the National Death Index (NDI), which according to the National Center for Health Statistics, accounted for only about 95% of all recorded US deaths in 2020 at the time of the NDI search (Ryff et al., 2022). Second, the MIDUS sampling frame excluded the institutionalized population, who suffered especially high mortality early during the early stages of the pandemic. Thus, mortality among the MIDUS cohort is likely to be lower than pandemic-related mortality for the population as a whole. Third, we have no information about the degree to which MIDUS participants complied with public health orders during the pandemic and whether it differed by personality. Nor do we have any information about self-destructive behaviors (e.g., alcohol and drug abuse) during the pandemic. Fourth, personality was measured in 1995-96, approximately 25 years prior to the pandemic. Finally, the MIDUS sample under-represents minorities, who suffered higher mortality during the pandemic. Future Analyses: It will be useful to replicate this analysis using the Health Retirement Survey (HRS), which samples Americans older than 50, once mortality data become available for 2020. HRS has a much larger sample than MIDUS and thus, will yield more statistical power for modeling excess mortality. HRS also has a more ethnically dive...

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    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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  2. Version published to 10.1101/2022.05.24.22275508v1 on medRxiv