Effects of social network diversity in the disablement process: A comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007-2015

Julia Schröders, Fatwa Sari Tetra Dewi, Maria Nilsson, Mark Nichter, Miguel San Sebastian

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Background: Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs - including Indonesia - epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes. Methods: Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses. Results: At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women. Conclusions: Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.

Original languageEnglish (US)
Article number128
JournalInternational Journal for Equity in Health
Issue number1
StatePublished - Jul 31 2020


  • Aging populations
  • Causal inference
  • Cognitive function
  • Disablement process
  • Instrumental variable
  • Lower-middle income countries
  • Non-communicable diseases
  • Outcome-wide epidemiology
  • Propensity score matching
  • Social network diversity

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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