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

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 outcomewide
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