Social connectedness, loneliness and preventive healthcare utilisation: a multilevel study of cancer screening in Europe using SHARE data

Abstract Population ageing has increased the importance of preventive healthcare utilisation, while highlighting persistent social differences in preventive services participation. This study examines whether structural and subjective dimensions of social frailty, captured respectively by limited social connectedness and loneliness, are associated with preventive healthcare utilisation among older adults in Europe. Using harmonised data from Wave 9 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the analysis covers individuals aged 50 and over in 22 European countries. Multilevel logistic regression models are estimated to assess the association between the two selected dimensions and participation in mammography and colorectal cancer screening, while accounting for individual-level demographic, socioeconomic and health-related characteristics, as well as cross-national heterogeneity. The results show that limited social connectedness is consistently associated with higher risks of colorectal cancer screening and mammography non-attendance, whereas loneliness displays a weaker and more outcome-specific association, being related to mammography but not to colorectal cancer screening on average. Moreover, the strength of the association between social connectedness and preventive healthcare utilisation varies across countries, indicating the relevance of national contexts. Overall, the findings highlight the importance of distinguishing between structural and subjective dimensions of social frailty in quantitative analyses of preventive healthcare utilisation and underscore the value of multilevel approaches in assessing cross-national variation in preventive care participation.