中老年高血压患者抑郁发病风险及影响因素研究

Factors associated with depression in middle-aged and the elderly with hypertension

目的了解中国中老年高血压患者抑郁发病风险及影响因素。方法采用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据库中2011年基线数据,2013年、2015年、2018年随访数据构建队列,最终选取基线3386名高血压非抑郁患者为研究对象。收集其基本信息,体格检查和血液检查信息,随访3次发生抑郁的情况。结果3次随访高血压患者发生抑郁1207例,累积发病率35.65%。Cox回归分析显示,农村地区(HR=1.39,95%CI:1.23~1.58);女性(HR=1.44,95%CI:1.26~1.66);受教育程度为文盲(HR=2.25,95%CI:1.30~3.89)、小学(HR=2.34,95%CI:1.37~4.00)、初中(HR=1.82,95%CI:1.06~3.13);自评健康一般(HR=1.20,95%CI:1.04~1.39)、差(HR=1.73,95%CI:1.44~2.07);生活不满意(HR=1.67,95%CI:1.38~2.01);疼痛(HR=1.20,95%CI:1.05~1.38);没有医疗保险(HR=1.26,95%CI:1.01~1.58)和糖化血红蛋白异常(HR=1.07,95%CI:1.00~1.15)是高血压患者发生抑郁的危险因素。结论我国中老年高血压人群抑郁的发病率较高,基层医疗卫生机构或医院在针对高血压患者的防治措施中,不仅要关注患者的血压控制水平,而且要重点对患者进行心理疏导,及时进行干预,提高患者生活质量。

Objective To explore the factors associated with depression in middle-aged and the elderly with hypertension.Methods The baseline data of 2011as well as the follow-up data of 2013,2015and 2018were retrieved from China Health and Retirement Longitudinal Study(CHARLS)database and were used to construct a study cohort and a total of 3386non-depressed subjects with hypertension at baseline were selected.Their basic information,physical examination and blood test information were acquired and 3times followup were performed to trace the depression condition.Cox regression was used to analyze the influencing factors for depression in subjects with hypertension during follow-up.Results After 3times of follow-up,1207 subjects with hypertension developed depression,with the cumulative incidence of 35.65%.Cox regression analysis showed that rural areas(HR=1.39,95%CI:1.23-1.58),women(HR=1.44,95%CI:1.26-1.66),poor-educated(illiterate:HR=2.25,95%CI:1.30-3.89;elementary school:HR=2.34,95%CI:1.37-4.00;junior high school:HR=1.82,95%CI:1.06-3.31),self-rated health condition as medium level and below(HR=1.20,95%CI:1.04-1.39;HR=1.73,95%CI:1.44-2.07),unsatisfied with life(HR=1.67,95%CI:1.38-2.01),pain(HR=1.20,95%CI:1.05-1.38),no health insurance(HR=1.26,95%CI:1.01-1.58)and abnormal glycosylated hemoglobin(HR=1.07,95%CI:1.00-1.15)were risk factors for depression in patients with hypertension.Conclusions The prevalence of depression in middle-aged and the elderly with hypertension is relatively high in China.Therefore,primary medical care centers and healthinstitutions or hospitals should not only focus on blood pressure control,but also on psychological counseling and timely intervention to improve the quality of life of patients with hypertension.