ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
This article is part of the Research TopicInnovative Strategies for Urban Public Health Resilience in Crisis SituationsView all 37 articles
Social Network Diversity and COVID-19 Infection and Severity Risk: A Longitudinal Population Study
Provisionally accepted
- 1Tokyo Kagaku Daigaku - Yushima Campus, Bunkyo, Japan
- 2Tokyo Kagaku Daigaku, Meguro, Japan
- 3Tohoku Daigaku, Sendai, Japan
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Background Clinical evidence on how social network diversity (SND) influences the risk of infection and disease severity during the coronavirus disease 2019 (COVID-19) pandemic remains limited. We aim to investigate the associations between SND and the risk of COVID-19 infection and disease severity using a large-scale longitudinal cohort study. Methods We analyzed data from participants in a longitudinal study, the Japan COVID-19 and Society Internet Survey (JACSIS) between 2020 and 2023. The SND score was calculated as the sum of seven distinct types of social networks. COVID-19 infection was assessed as ever infection, and severity was defined as oxygen-requiring admission, using a self-reported questionnaire. Poisson regression with robust standard errors estimated risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for sociodemographic and clinical characteristics. Results Of 13,713 participants (mean age 53.2±15.7 years, 46.4% women), 3,251 (23.7%) developed COVID-19, and among infected individuals, 277 (8.5%) required oxygen therapy. Higher SND scores were associated with COVID-19 infection with linear trend (SND score 7 vs. 0: adjusted RR 2.49; 95% CI 2.11-2.95). In contrast, the association between SND score and disease severity followed a U-shaped pattern, with 4-5 SND showing the lowest risk of oxygen-requiring admission (adjusted RR 0.15; 95% CI 0.11-0.30) compared to those with 0 SND. Conclusions While higher SND was associated with increased COVID-19 infection risk, moderate social network diversity appeared protective against severe disease outcomes. These findings suggest a complex trade-off between exposure risk and potential health benefits of social networks during infectious disease outbreaks.
Keywords: Social network diversity, Coronavirus Disease (COVID)-19, social determinants of health (SDOH), longitudinal cohort study, Infection
Received: 22 Oct 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Suzuki, Fujiwara and Tabuchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Takeo Fujiwara
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