In May 2023, the U.S. Surgeon General took the unusual step of issuing a formal advisory — the kind of public-health alarm normally reserved for tobacco or contaminated water — about something far harder to see on an x-ray: loneliness. The report, titled “Our Epidemic of Loneliness and Isolation,” laid out a striking claim. About half of American adults report experiencing loneliness, and the physical toll of chronic disconnection rivals that of well-known risks like smoking (US Surgeon General, 2023).
Loneliness is not the same as being alone. It is the painful, subjective feeling that your social relationships fall short of what you want or need. Social isolation is the more objective, measurable state of having few relationships or infrequent contact with others. A person can be isolated without feeling lonely, or feel deeply lonely in a crowded room. Both matter for health, and both have been drifting in the wrong direction for two decades.
This article walks through the numbers behind the loneliness epidemic: how widespread it is, the health risks the Surgeon General’s advisory documents, the long decline in time Americans spend together, and which groups carry the heaviest burden. If you or someone you know is struggling or in crisis, help is available. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7.
How Common Is Loneliness in America?
The headline figure from the Surgeon General’s advisory is that approximately half — about 50% — of U.S. adults report experiencing loneliness (US Surgeon General, 2023). That places loneliness among the most common conditions affecting the population, more widespread than most diagnosable mental illnesses tracked on our any mental illness overview.
Two features of the data make the problem especially difficult to address. First, loneliness is often invisible even to the people living with it. Fewer than 20% of people who say they often or always feel lonely or isolated recognize it as a major problem in their lives (US Surgeon General, 2023). When four in five affected people do not name the issue, it rarely prompts a doctor’s visit or a conversation with a friend.
Second, loneliness is not spread evenly across the life course. The advisory finds that loneliness is highest among young adults — a counterintuitive result for many, who tend to picture the lonely as elderly and homebound. Rates of reported loneliness generally decline with age into midlife, even as the health consequences of isolation grow more severe among older adults. We track both ends of that spectrum on our young adults and older adults population pages.
The Health Risks of Loneliness and Isolation
The advisory’s most attention-grabbing claim is that a lack of social connection can raise the risk of premature death about as much as smoking up to 15 cigarettes a day (US Surgeon General, 2023). That comparison, and the risk figures below, come from meta-analyses that pool large observational studies. They describe associations between poor social connection and worse health outcomes — not proven cause and effect. People who are isolated may differ from the well-connected in many ways, and researchers cannot randomly assign anyone to a lonely life. With that caveat firmly in mind, the pooled estimates are sobering.
| Outcome | Associated risk (vs. better-connected people) |
|---|---|
| Premature death — loneliness | +26% increased risk |
| Premature death — social isolation | +29% increased risk |
| Mortality risk — general | Comparable to smoking up to 15 cigarettes/day |
| Heart disease | +29% increased risk |
| Stroke | +32% increased risk |
| Dementia (older adults) | ~50% increased risk |
| Odds of survival (strong social connection) | +50% greater odds |
| Excess Medicare spending (social isolation, older adults) | ~$6.7 billion per year |
Loneliness increases the risk of premature death by an estimated 26%, and social isolation by 29% (US Surgeon General, 2023). Poor or insufficient social connection is associated with a 29% higher risk of heart disease and a 32% higher risk of stroke. Among older adults, chronic loneliness and isolation are linked to roughly a 50% increased risk of developing dementia. On the positive side, a synthesis of 148 studies found that strong social connection is associated with a 50% increase in the odds of survival — evidence that relationships appear to protect health, not only that their absence harms it.
The costs are economic as well as human. The advisory cites an estimate that social isolation among older adults accounts for approximately $6.7 billion in excess Medicare spending each year (US Surgeon General, 2023), a reminder that disconnection ripples outward into the health system.
A Nation Spending Less Time Together
Why frame loneliness as an epidemic now? Because the raw behavioral data show Americans steadily withdrawing from one another over the two decades leading up to 2020. Drawing on time-use surveys, the advisory documents a sharp fall in the hours people spend in each other’s company.
| Measure | 2003 | 2020 |
|---|---|---|
| In-person time with friends (all adults) | 60 min/day | 20 min/day |
| In-person time with friends (ages 15–24) | ~150 min/day | 40 min/day (~70% drop) |
| Time spent alone | 285 min/day | 333 min/day |
| Single-person households (1960 → 2022) | 13% | 29% |
Between 2003 and 2020, the average time Americans spent in person with friends fell from about 60 minutes a day to just 20 minutes a day — a two-thirds decline (US Surgeon General, 2023, citing time-use data). The drop was steepest among the young: for people ages 15 to 24, in-person time with friends fell roughly 70%, from about 150 minutes a day in 2003 to around 40 minutes in 2020. Over the same period, time spent alone rose from 285 to 333 minutes a day.
Longer-run demographic shifts point in the same direction. The share of Americans living alone in single-person households more than doubled, climbing from 13% in 1960 to 29% by 2022 (US Surgeon General, 2023, citing Census data). More people living solo does not automatically mean more loneliness, but combined with the collapse in face-to-face friend time, it describes a society structurally arranged for less daily contact than the one that preceded it.
Does technology explain the decline?
It is tempting to pin the entire trend on smartphones and social media, but the evidence supports a more careful reading. The advisory notes that among adults, those using social media more than two hours a day had about double the odds of reporting increased perceived social isolation compared with those using it less than 30 minutes a day (US Surgeon General, 2023). A separate cross-sectional study of young adults, based on 2014 survey data, found that people in the highest quartile of time spent on social media had roughly twice the odds of high perceived social isolation compared with the lowest quartile (Primack et al., 2017).
Both findings are correlational. They cannot tell us whether heavy social media use deepens isolation, whether already-isolated people turn to their phones to cope, or both. We explore that two-way relationship in depth in our companion piece on social media and mental health statistics. What the loneliness data make clear is that the decline in in-person time is real regardless of its cause.
Who Is Most Affected
Loneliness and isolation follow different patterns across the population, which is part of what makes the epidemic hard to summarize in a single number.
Young adults report the highest rates of loneliness itself. This is the group that saw the largest decline in face-to-face friend time, and the same cohort most exposed to a social landscape reshaped by digital communication. High loneliness in early adulthood is concerning in part because of its links to depression and anxiety — loneliness and depressive symptoms tend to travel together, each capable of feeding the other. Our guide to how many people have depression shows that young adults ages 18 to 25 already carry the highest adult depression rates.
Older adults face the reverse profile: they report loneliness less often on average, but they bear the heaviest health consequences of isolation. The dementia and mortality risks, and nearly all of the $6.7 billion in excess Medicare spending, concentrate in this group. Life events common in later years — retirement, bereavement, reduced mobility, and hearing loss — can quietly shrink a person’s social world.
The workplace matters too, because for many adults it is the primary source of daily social contact. Shifts toward remote and hybrid work have changed how, and how often, colleagues interact. Our overview of mental health in the workplace examines how employers factor into connection and well-being.
Frequently Asked Questions
How many Americans are lonely?
According to the 2023 U.S. Surgeon General’s advisory, about half — roughly 50% — of U.S. adults report experiencing loneliness (US Surgeon General, 2023). Loneliness is a subjective feeling, so estimates vary with how surveys ask the question, but this is the figure the federal advisory highlights.
Is loneliness really as bad for you as smoking?
The advisory reports that a lack of social connection is associated with a risk of premature death comparable to smoking up to 15 cigarettes a day (US Surgeon General, 2023). This comes from observational meta-analyses and reflects a statistical association, not proof that loneliness causes death the way smoking causes disease.
Which age group is loneliest?
Young adults report the highest rates of loneliness, according to the Surgeon General’s advisory (US Surgeon General, 2023). Older adults report loneliness less often but experience the most severe health consequences of social isolation, including a roughly 50% higher risk of dementia.
How much has time with friends declined?
Between 2003 and 2020, average in-person time with friends fell from about 60 minutes a day to about 20 minutes a day among all adults, and roughly 70% among people ages 15 to 24 (US Surgeon General, 2023). Time spent alone rose from 285 to 333 minutes a day over the same period.
Does social media cause loneliness?
The evidence is associational, not causal. Adults using social media more than two hours a day had about double the odds of reporting increased perceived social isolation (US Surgeon General, 2023), but such studies cannot establish direction. Heavy use may worsen isolation, isolation may drive heavier use, or both may be true.
What can help with loneliness?
The Surgeon General’s advisory frames social connection as something individuals, communities, workplaces, and institutions can actively rebuild — through more frequent in-person contact, community participation, and policies that make gathering easier. Anyone in emotional distress or crisis can call or text 988 for free, confidential support 24/7.
Sources
- Office of the U.S. Surgeon General. Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. HHS; 2023. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
- Office of the U.S. Surgeon General. Our Epidemic of Loneliness and Isolation (record). HHS; 2023. https://pubmed.ncbi.nlm.nih.gov/37792968/
- Primack BA, et al. Social Media Use and Perceived Social Isolation Among Young Adults in the U.S. Am J Prev Med. 2017. https://pubmed.ncbi.nlm.nih.gov/28279545/