Loneliness among Older Adults with Multiple Chronic Conditions: Exploring Disparities for Hispanic Adults in the 2023 Behavioral Risk Factor Surveillance System

Abstract

Objectives:

Loneliness among older adults is a public health concern negatively impacting those with multimorbidity. As the population continues to age in the United States and the proportion of Hispanics grows, understanding the relationship between loneliness and multimorbidity for Hispanic older adults warrants further examination. Previous studies have explored loneliness and multimorbidity, but examine the impact on Hispanic older adults. To achieve this aim, we assessed loneliness and disparities in the dose-response relationship of multimorbidity in adults aged 65+.

Study Design:

Cross-sectional observational study using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS).

Methods:

Weighted analyses represented U.S. adults aged 65+. Descriptive statistics and chi-square tests compared prevalence by ethnicity. Multivariable logistic regression models identified factors associated with loneliness in the overall sample and Hispanic subgroup. Predicted probabilities were plotted to highlight differences by race, ethnicity, and sex.

Results:

Among U.S. adults aged 65+, 35.0% reported feeling lonely. Hispanic older adults reported a higher prevalence of loneliness than non-Hispanic older adults (40.2% vs 34.5%) and were more likely to receive inadequate social support (10.7% vs 6.3%). Hispanic females showed the strongest dose-response effect, with loneliness increasing from 41% (no conditions) to 57% (3+ conditions).

Conclusions:

Being Hispanic, regardless of sex, increased likelihood of loneliness and inadequate social support; however, Hispanic older females face the highest levels of loneliness when managing multimorbidity with inadequate social support compared to Hispanic males and individuals of other races/ethnicities. Further research is needed to address these disparities for Hispanics and women in particular.

1. Introduction

Chronic conditions have emerged as a central challenge for global public health systems due to population aging over the past several decades. Technological advancements in healthcare and improved standards of living have driven a surge in life expectancy worldwide, resulting in people living longer but often with multiple chronic conditions. In the United States (U.S.), the proportion of adults aged 65+ has almost doubled from 9.2% in 1960 to 16.9% in 2020.¹ Simultaneously, the prevalence of adults with at least one chronic condition has increased almost five-fold, from approximately 10% in 1960 to over 60% by 2024.² Heart disease, cancer and diabetes constitute the most common chronic conditions in the US and represent the leading causes of death and disability nationwide.^3–5 These demographic and epidemiological shifts have placed immense pressure on healthcare systems as they adapt to managing chronic conditions effectively while aiming to both extend lifespan and improve health-related quality of life.

A particularly concerning trend is the rise of multimorbidity, defined as the presence of two or more chronic conditions in an individual. The prevalence of multimorbidity in the U.S. population has increased dramatically from approximately 5% in 1960 to more than 40% in 2024.² Individuals living with multimorbidity experience poorer health-related quality of life, increased healthcare utilization, and higher mortality rates.⁶ Management of multiple chronic conditions is more complex than addressing each disease in isolation, often leading to fragmented care, polypharmacy, and reduced treatment adherence.^7,8

1.1. Loneliness and social support

Another major public health concern is loneliness that prompted the U.S. Surgeon General to issue a 2023 advisory declaring it an epidemic.⁹ Loneliness, the subjective emotional distress resulting from inadequate physical and emotional connection, affects millions of Americans.^10,11 Approximately 50% of U.S. adults report experiencing loneliness, though prevalence tends to decrease in older age groups.^12,13 The health consequences of loneliness are substantial, with research linking it to increased risks of chronic conditions and a 26% to 29% increased risk of premature death, exceeding the mortality impacts of obesity and physical inactivity.^14,15 Key social determinants including marital status, poverty, and living arrangements have consistently demonstrated strong correlations with loneliness outcomes.^16–19

For older adults with multimorbidity, the health implications of loneliness become pronounced, as these individuals often experience a lack of social and emotional support that further compromises their health status.^20–22 Studies have shown that older adults managing multiple chronic conditions experience 8% higher levels of loneliness and 10% greater social exclusion, largely because their health conditions restrict social interactions and activities.^23,24 While loneliness affects all demographic groups, important disparities exist: Hispanic older adults report the highest rates of always or often feeling lonely at 9%, compared to 7% of the general older adult population.²⁵

Cultural and linguistic differences significantly influence perceptions of loneliness across population groups, particularly when comparing family-oriented cultures to more individualistic ones.^26–28 Among Hispanic communities, familismo, a cultural value system that prioritizes family relationships over individual needs, plays a crucial role in shaping experiences of loneliness among older adults.^29–31 This cultural framework can serve a dual function: potentially buffering against isolation through strong family connections, while at the same time intensifying feelings of loneliness when family support is perceived as inadequate or absent. Previous studies show complex and at times contradictory perspectives on familismo and its influence on loneliness.^32,33

This study seeks to address critical gaps in the literature about loneliness among Hispanic older adults with multiple chronic conditions. Using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data, we examine relationships between loneliness, insufficient social and emotional support, and multimorbidity, while controlling key sociodemographic factors. Our primary research question explores the disparities experienced by Hispanic older adults aged 65+ compared to other demographic groups. We hypothesize that Hispanic older adults with multimorbidity will demonstrate significantly higher odds of loneliness and inadequate social and emotional support with a dose-response relationship showing increasing vulnerability as the number of chronic conditions rises.

2. Methods

2.1. Data Source

The BRFSS is a yearly cross-sectional survey carried out by the Centers for Disease Control and Prevention (CDC) in collaboration with 54 health departments across U.S. states, districts, and territories. It evaluates health risk behaviors, chronic diseases, and mental health among other measures of health and wellbeing in the U.S. The survey includes a standardized core questionnaire, supplemented by optional modules used in specific states and territories. The CDC has detailed the design, sampling methods, data collection processes, and weighting procedures.³⁴ In 2023, the optional social determinants and health equity module gathered responses from 39 states, Puerto Rico, and the District of Columbia, and included a novel item asking respondents about loneliness. The analysis was restricted to the states, Puerto Rico, and the District of Columbia that included the optional module and to adults aged 65+ for a final analytical sample size of 116,359 respondents.

2.2. Measures

2.2.1. Outcome variable

We measured the frequency of loneliness using the question “How often do you feel lonely?” from the social determinants and health equity module as the outcome measures in our models. A five-point Likert scale with options including always, usually, sometimes, rarely, or never were possible responses. We dichotomized the responses as always/usually/sometimes and rarely/never for consistency of measurement across other studies conducted by researchers at the CDC who had developed this measure.^35,36

2.2.2. Sociodemographic variables

Race and ethnicity were initially collected as separate items and later combined by CDC researchers into a single variable available in the public access dataset with five categories: non-Hispanic Black; Hispanic; non-Hispanic multiracial; non-Hispanic other race; and non-Hispanic White. Sex was categorized as male or female. Marital status was grouped into three categories: widowed/divorced/separated, single, and married/member of an unmarried couple. Language preference was determined by whether the survey interview was conducted in English or Spanish. Socioeconomic status in our study was measured through educational attainment, which was categorized as: less than high school education, high school graduate, some college or technical school, and graduated from college or technical school.

2.2.3. Lack of Social and Emotional Support

The BRFSS asks respondents, “How often do you get the social and emotional support you need?” with options ranging from never, rarely, sometimes, usually, to always using a five-point Likert scale. We dichotomized responses as always/usually/sometimes and rarely/never for our main exposure variable of interest based on previous studies conducted by the CDC using this item.^35,36

2.2.4. Chronic conditions

We assessed the number of leading conditions resulting in chronic disease mortality based on dichotomous responses (yes/no) to self-reported history of cancer, chronic lung disease, cardiovascular disease, diabetes, stroke, and/or kidney disease. These items were summed in a single chronic condition(s) variable and categorized with the following levels: no chronic conditions, one chronic condition, two chronic conditions, and three or more chronic conditions. Other items in the chronic conditions section including asthma and arthritis were excluded due to their relatively low impact on mortality outcomes in older adults compared to the leading causes of mortality in the U.S.

2.3. Statistical analysis

We determined the appropriate weights for all survey versions by following previously outlined analysis methods for the BRFSS social determinants and health equity modules.³⁴ Sample distributions were used to describe the frequency of categorical variables within the study. Rao-Scott chi-square tests were employed for bivariable comparisons by Hispanic ethnicity to evaluate the variation in proportions of the categorical variables. To assess loneliness, we performed adjusted, multivariable logistic regression analyses separately for the full analytical sample and the Hispanic subgroup controlling for sociodemographic variables and examined interaction effects in subsequent logistic regressions. All analyses were conducted using SAS version 9.4 (SAS Institute, Inc., Cary, NC).

3. Results

3.1. Sample distribution

Among adults aged 65+, non-Hispanic White adults were the majority at 72.9%, followed by non-Hispanic Black adults (10.6%) and Hispanic adults (8.7%; Table 1). Most were female (55.3%), and 44.7% were males. Respondents were primarily married/member of an unmarried couple (57.2%) or widowed/divorced/separated (36.9%) with only 5.9% single. Most responded to the survey in English (95.4%) compared to only 4.6% of the surveys in Spanish. Over a third of the respondents (35.0%) reported feeling lonely (always/usually/sometimes), and 6.7% reported they rarely/never received the social and emotional support that they needed. Most attested to not having any chronic conditions (44.9%) with 33.2% having one condition, 14.6% having two conditions, and 7.3% having three or more conditions.

Table 1.

Sample distribution of US adults aged 65+ years and bivariable comparisons by Hispanic ethnicity

	Full Sample		Non-Hispanic Adults		Hispanic Adults		p-Value
	N	%	n	%	n	%
Race/ethnicity							-
Non-Hispanic Black	7,551	10.6	7,551	11.6	-	-
Hispanic	4,731	8.7	-	-	4,731	100.0
Non-Hispanic multiracial	1,655	1.6	1,655	1.7	-	-
Non-Hispanic other race	4,085	6.2	4,085	6.8	-	-
Non-Hispanic White	95,939	72.9	95,939	79.9	-	-
Sex							0.6509
Male	51,001	44.7	49,022	44.8	1,979	44.1
Female	65,361	55.3	62,609	55.2	2,752	55.9
Marital status							<0.0001
Widowed/divorced/separated	45,849	36.9	43,773	36.2	2,076	44.5
Single	7,217	5.9	6,861	5.9	356	6.0
Married/member of an unmarried couple	62,455	57.2	60,183	57.9	2,272	49.6
Survey language preference							<0.0001
Spanish	2,472	4.6	75	0.1	2,397	53.6
English	113,887	95.4	111,556	99.9	2,331	46.4
Educational attainment							<0.0001
Did not graduate high school	6,039	11.2	4,672	8.1	1,367	44.0
Graduated high school	29,205	27.2	28,076	27.7	1,129	21.7
Some college or technical school	31,990	31.3	30,956	32.4	1,034	19.9
Graduated from college or technical school	48,624	30.3	47,451	31.8	1,173	14.4
Frequency of loneliness							<0.0001
Always/usually/sometimes	38,097	35.0	36,301	34.5	1,796	40.2
Rarely/never	77,486	65.0	74,596	65.5	2,890	59.8
Frequency of social and emotional support							<0.0001
Rarely/never	6,804	6.7	6,323	6.3	481	10.7
Always/usually/sometimes	107,439	93.3	103,268	93.7	4,171	89.3
Number of chronic conditions							0.0378
0	53,133	44.9	50,958	44.8	2,175	45.5
1	38,194	33.2	36,593	33.1	1,601	34.9
2	16,702	14.6	16,041	14.7	661	13.9
3+	8,333	7.3	8,039	7.5	294	5.6

Note: P values are Rao-Scott chi-square tests comparing the weighted proportions of non-Hispanic and Hispanic respondents for each variable and are bold where significant (p<0.05).

3.2. Bivariable comparisons

Hispanic adults (44.5%) experienced a higher prevalence of being widowed/divorced/separated and a lower prevalence of being married/member of an unmarried couple (49.6%) compared to widowed/divorced/separated (36.2%) and married/living as married (57.9%) non-Hispanic adults (p<0.0001; Table 1). Hispanic adults experienced a higher prevalence of feeling lonely (40.2% compared to 34.5% of non-Hispanic adults; p<0.0001) and rarely/never receiving the social and emotional support that they needed (10.7% compared to 6.3% of non-Hispanic adults; p<0.0001). Non-Hispanic adults had a higher prevalence of three or more chronic conditions (7.5% versus 5.6% of Hispanic adults; p=0.0378), while a larger share of Hispanic adults had one chronic condition compared to non-Hispanic adults (34.9% versus 33.1%; p=0.0378).

3.3. Multivariable logistic regressions

Among all adults aged 65+, non-Hispanic Black (adjusted odds ratio [aOR]: 1.26; 95% confidence interval [CI]: 1.14–1.38), Hispanic (aOR: 1.41; CI: 1.19–1.68), and non-Hispanic respondents of another race (aOR: 1.53; CI: 1.28–1.83) experienced increased odds of feeling lonely (always/usually/sometimes) compared to non-Hispanic White respondents (Table 2). Males (aOR: 0.89; CI: 0.84–0.95) had lower odds of feeling lonely compared to females. Those who were widowed/divorced/separated (aOR: 2.10; CI: 1.98–2.24) and single (aOR: 1.78; CI: 1.57–2.02) had higher odds of feeling lonely compared to those who were married/living as married. Those who did not graduate high school (aOR: 1.69; CI: 1.50–1.90), high school graduates (aOR: 1.32; CI: 1.23–1.41), and those with some college or technical school (aOR: 1.17; CI: 1.09–1.26) experienced increased odds of feeling lonely compared to those who graduated from college or technical school. Respondents reporting two (aOR: 1.22; CI: 1.13–1.34) or three or more (aOR: 1.39; CI: 1.24–1.54) chronic conditions had higher odds of feeling lonely compared to those with no chronic conditions.

Table 2.

Odds of feeling lonely (always/usually/sometimes) among US adults aged 65+

	All adults				Hispanic adults
	aOR	95% CI			aOR	95% CI
Race/ethnicity		LL	UL
Non-Hispanic Black	1.26	1.14	1.38		-	-	-
Hispanic	1.41	1.19	1.68		-	-	-
Non-Hispanic other, multiracial	1.53	1.28	1.83		-	-	-
Non-Hispanic White	Ref.				-	-	-
Sex
Male	0.89	0.84	0.95		0.91	0.72	1.14
Female	Ref.				Ref.
Marital status
Widowed/divorced/separated	2.10	1.98	2.24		1.84	1.45	2.35
Single	1.78	1.57	2.02		1.24	0.77	2.01
Married/member of an unmarried couple	Ref.				Ref.
Survey language preference
English	1.58	1.25	2.00		1.45	1.14	1.85
Spanish	Ref.				Ref.
Educational attainment
Did not graduate high school	1.69	1.50	1.90		1.25	0.93	1.69
Graduated high school	1.32	1.23	1.41		1.24	0.90	1.70
Some college or technical school	1.17	1.09	1.26		0.83	0.59	1.17
Graduated from college or technical school	Ref.				Ref.
Frequency of social and emotional support
Rarely/never	1.08	0.95	1.24		1.37	0.97	1.95
Always/usually/sometimes	Ref.				Ref.
Number of chronic conditions
0	Ref.				Ref.
1	1.06	0.99	1.14		1.11	0.86	1.44
2	1.23	1.13	1.34		1.48	1.04	2.11
3+	1.39	1.24	1.54		2.00	1.34	2.98

Note: aOR=adjusted odds ratio; CI=confidence interval; LL=lower limit; UL=upper limit. Significant results (95% CI does not contain 0) are bold for emphasis.

The second logistic regression model only considered Hispanic adults aged 65+ for comparison (Table 2). Those who were widowed/divorced/separated (aOR: 1.84; CI: 1.45–2.35), answered the survey in English (aOR: 1.45; CI: 1.14–1.85) and living with two (aOR: 1.48; CI: 1.04–2.11) and three or more (aOR: 2.09; CI: 1.07–3.36) chronic conditions experienced higher odds of feeling lonely compared to their counterparts.

3.4. Interaction effects

To assess the relationship among social and emotional support, and chronic conditions on loneliness, we tested interaction effects in two separate logistic regressions (data not shown) and graphed the predicted probabilities of significant interactions for interpretability (Figs. 1 & 2).

Fig. 1.

Predicted probabilities of feeling lonely (always/usually/sometimes) by number of chronic conditions, sex, and frequency of social and emotional support (always/usually/sometimes vs. rarely/never).

Fig. 2.

Predicted probabilities of feeling lonely (always/usually/sometimes) by number of chronic conditions, sex, and race/ethnicity (NH=non-Hispanic).

The first regression model examined the interaction among sex, number of chronic conditions and social and emotional support on feeling lonely (Fig. 1). For both sexes, loneliness increased with a greater number of chronic conditions regardless of the level of social and emotional support received. Females who rarely/never received needed social and emotional support had the highest range of probabilities for loneliness from approximately 44% to 52%, compared to 34% to 47% for those who always/usually/sometimes received needed social and emotional support. The probabilities were lower for males, ranging from 30% to 38% for those who always/usually/sometimes received needed social and emotional support and 32% to 45% for those lacking needed social and emotional support.

We performed an additional logistic regression and observed a significant interaction among sex, race/ethnicity, and number of chronic conditions (Fig. 2). Among all groups, those with more chronic conditions experienced a higher probability of loneliness. Females generally experienced higher probabilities of loneliness, except for non-Hispanic, other/multiracial individuals where males with 3+ chronic conditions had elevated probabilities of loneliness compared to females with 3+ chronic conditions. Hispanic females with 3+ chronic conditions had the highest probability of loneliness at 57% compared to all other groups closely followed by non-Hispanic Black females at 54%. Hispanics with 3+ chronic conditions also had the widest variation in probabilities of loneliness ranging at 16% (males: 41% and females: 57%) compared to other racial/ethnic categories. Other racial/ethnic groups ranged less than 10% between males and females across the number of chronic conditions.

3.5. Sensitivity analyses

Compared to the main results in Table 2, the sensitivity analyses in Appendix 2, which use a stricter definition of loneliness (always/usually vs. sometimes/rarely/never), showed fewer statistically significant associations and generally larger effect sizes for key predictors. In the full sample, the associations between loneliness and race/ethnicity observed in Table 2 were attenuated and no longer significant in Appendix 2. However, the relationships for marital status, low educational attainment, limited emotional support, and multiple chronic conditions remained strong and significant, often with higher odds ratios. Among Hispanic older adults, patterns were similar, though wide confidence intervals reduced precision. Overall, the sensitivity analysis supports the robustness of the main findings.

4. Discussion

This study focused on the intersection of loneliness, social and emotional support, and multimorbidity while highlighting disparities experienced by Hispanic older adults consistent with findings from other studies.²⁵ Our results revealed that Hispanic older adults had a significantly higher prevalence of loneliness compared to non-Hispanic adults and were more likely to report rarely or never receiving needed the social and emotional support. Importantly, we identified a dose-response relationship demonstrating that the predicted probability of loneliness increased with chronic disease burden, particularly for females with three or more chronic conditions.

Several factors may contribute to these disparities. Lower marriage rates among Hispanic respondents in our sample may have influenced loneliness outcomes, consistent with the established association between marital status and loneliness.^16–19 However, this finding is counterintuitive given that trend studies have indicated low rates of divorce rates among immigrant Hispanic women, though notably higher rates among US-born Hispanic women.³⁷ Differing life expectancies, generally higher for both Hispanic men and women, may also play a role, though these effects are moderated by generation (i.e., immigrant) and acculturation.³⁸ Our Hispanic sample may represent more US-born characteristics, as suggested by education findings that align with the literature showing lower education levels among immigrant Hispanic parents in this age range³⁹ and established associations between lower educational attainment and poorer health outcomes.⁴⁰

Our findings should be interpreted with the context of inconsistent evidence in literature. Studies from the US suggest that immigrant Hispanic individuals typically benefit from stronger social ties and social support networks that helps mitigate loneliness.⁴¹ However, a recent review suggests differences in loneliness between White and Hispanic populations are often not found in most studies.⁴² The education and marital status patterns we observed, along with indications that our sample my represent more US-born characteristics, suggests that later-generation Hispanic individuals may experience rates of loneliness comparable to other US-born racial/ethnic groups and may not benefit from the robust support structures that often protect immigrant Hispanic populations.

A recent review found only eight, international studies examining the relationships among multimorbidity, loneliness, and social isolation in older adults, with a significant gap in a focus on Hispanic health disparities.⁴³ As the United States becomes increasingly diverse with Hispanic Americans projected to comprise over 30% of the population by 2050, the demographic landscape of the nation will demand from policymakers a deeper understanding of how multimorbidity, loneliness, and social isolation particularly affect Hispanic older adults. Our study provides updated evidence of these patterns and corroborates the relationship between multimorbidity in loneliness and the dose-response of increased loneliness with greater numbers of chronic conditions in a large sample of U.S. older adults.

4.1. Limitations

This study is limited in several ways. First, the BRFSS uses computer aided telephone interviewing to sample the population, potentially leading to sampling bias for those who do not have a landline or cellphone. This approach limits data on chronic conditions and other measures to self-report without clinical diagnoses from electronic health records. The data are cross-sectional, and we cannot ascertain the directionality of these relationships. Living with chronic conditions may contribute to loneliness, or loneliness may be a factor leading to chronic conditions and multimorbidity.

The social determinants and health equity module was also not administered across all geographic entities. Notably, these findings exclude Texas, a state with one of the largest Hispanic populations in the US. The lack of data on Texas older adults may bias these findings compared to other states and territories, such as New York and Puerto Rico, with a different profile of Hispanic individuals. A key limitation is that Hispanic ethnicity, including mixed heritage, was categorized based on self-reported BRFSS data using CDC recodes, which may oversimplify cultural and ethnic nuances and limit the ability to capture within-group diversity. The use of the monolithic term “Hispanic” limits a nuanced understanding of within group differences in this ethnic group that cannot be ascertained in the BRFSS including nativity and immigration status. Another limitation is that the BRFSS lacks detailed measures of generational status and acculturation among Hispanic respondents, restricting analysis of these factors beyond the proxy of survey language used.

4.2. Conclusions

Findings from this study underscore the need for public health policies and practices that integrate social-connection strategies into chronic disease prevention and management among Hispanic older adults. In practice, community health screening programs could include brief loneliness assessments during routine check-ups and create referral pathways to culturally and linguistically tailored social support services. Health systems and public health departments might also partner with Hispanic community organizations to implement “social prescribing” approaches linking lonely older adults to bilingual community health workers, local activity groups, or virtual peer-support sessions.

Policy level approaches could include targeted funding for community-led connection programs, small-grant mechanisms for grassroots organizations serving Hispanic older adults, and investments in digital inclusion efforts to reduce isolation among those with limited mobility or English proficiency. Finally, routine monitoring systems could integrate loneliness indicators into multimorbidity surveillance to help policymakers track progress and allocate resources where social and health vulnerabilities overlap. Collectively, these steps would operationalize our findings into actionable strategies that align with the priorities of public health practitioners and decision-makers.

Appendix 1. Bivariable comparison of feeling lonely (always/usually) by Hispanic ethnicity

	Full Sample		Non-Hispanic Adults		Hispanic Adults		p-Value
	N	%	n	%	n	%
Frequency of loneliness							<0.0001
Always/usually	4,187	4.3	3,821	3.9	366	8.6
Sometimes/rarely/never	98,801	95.7	94,976	96.1	3,825	91.4

Note: P value is the Rao-Scott chi-square test comparing the weighted proportions of non-Hispanic and Hispanic respondents by frequency of loneliness and is bold where significant (p<0.05).

Appendix 2. Odds of feeling lonely (always/usually) among US adults aged 65+

	All adults				Hispanic adults
	aOR	95% CI			aOR	95% CI
		LL	UL			LL	UL
Race/ethnicity
Non-Hispanic Black	0.87	0.65	1.18		-	-	-
Hispanic	1.02	0.67	1.54		-	-	-
Non-Hispanic other, multiracial	1.22	0.81	1.83		-	-	-
Non-Hispanic White	Ref.				-	-	-
Sex
Male	0.92	0.79	1.08		0.86	0.56	1.32
Female	Ref.				Ref.
Marital status
Widowed/divorced/separated	3.05	2.53	3.68		2.34	1.45	3.75
Single	2.05	1.53	2.77		1.02	0.51	2.07
Married/member of an unmarried couple	Ref.				Ref.
Survey language preference
English	0.46	0.28	0.74		0.45	0.27	0.76
Spanish	Ref.				Ref.
Educational attainment
Did not graduate high school	2.00	1.53	2.61		1.65	0.95	2.86
Graduated high school	1.51	1.24	1.85		1.32	0.74	2.36
Some college or technical school	1.32	1.10	1.58		1.30	0.69	2.43
Graduated from college or technical school	Ref.				Ref.
Frequency of social and emotional support
Rarely/never	4.61	3.84	5.53		2.58	1.70	3.91
Always/usually/sometimes	Ref.				Ref.
Number of chronic conditions
0	Ref.				Ref.
1	1.26	1.05	1.50		1.57	1.03	2.40
2	1.78	1.44	2.21		1.41	0.83	2.38
3+	2.48	1.94	3.16		2.14	1.17	3.92

Note: aOR=adjusted odds ratio; CI=confidence interval; LL=lower limit; UL=upper limit. Significant results (95% CI does not contain 0) are bold for emphasis.

Data availability statement:

The data that support the findings of this study are openly available at https://www.cdc.gov/brfss/.