Examining associations of changes in social connectedness with healthcare utilization and costs: A prospective study among Singapore adults

Social isolation and loneliness are linked with adverse health outcomes, potentially increasing healthcare demands, yet their impacts on healthcare utilization in Singapore remain underexplored. This longitudinal study examined how temporal changes in social connectedness impact subsequent healthcare utilization and costs. Data from a population health survey were linked with an administrative healthcare database, and participants without any records were excluded. Social isolation and loneliness were assessed with the Lubben Social Network Scale-6 and three-item UCLA Loneliness Scale, respectively. Baseline characteristics were compared using Chi-square or Kruskal-Wallis H tests. Two-step hurdle models investigated the associations between status change and subsequent healthcare utilization and costs, adjusting for baseline values and covariates. Among 1,182 participants (55% female; 61.3% aged < 60), 11.2% became socially disconnected and 15.2% became socially connected. Persistent social disconnection (16.9%) was associated with increased hospitalizations, polyclinic visits, and ED visits, and higher hospitalizations and ED costs, at both one-year and three-year follow-ups, compared to those who remained socially connected (56.7%). Becoming socially connected showed protective effects for subsequent hospitalizations and polyclinic visits, but not for ED visits and associated costs. Among healthcare users, alleviating social isolation and loneliness could help reduce costly hospitalizations and ease resource strains on polyclinic services.