我国中老年人抑郁症状与心血管代谢性共病轨迹的相关性研究

Correlation between depressive symptoms and cardiovascular-metabolic comorbidities trajectories in middle-aged and elderly of China

目的了解中国45岁及以上人群抑郁症状与心血管代谢性共病(CMM)轨迹的相关性,为中老年人群CMM的预防控制和健康管理提供依据。方法基于2015年和2018年中国健康与养老追踪调查(CHARLS)数据,纳入2015年调查时非CMM的中老年人11182名作为研究对象,调查内容包括基本信息、慢性病患病情况和抑郁症状测量情况,CMM变化轨迹信息来自2018年数据。采用Stata 16.0软件进行t检验、Kruskal-Wallis H检验、χ^(2)检验和多分类logit模型分析。结果2015—2018年,11182名研究对象中,7736人(69.18%)心血管代谢性疾病(CMD)状态未发生变化,1686人(15.08%)从无CMD发展为1种CMD,645人(5.77%)从无CMD发展为CMM,1115人(9.97%)从1种CMD发展为CMM。多分类logit模型分析结果显示,与无抑郁症状人群相比,有抑郁症状的人从无心血管代谢性疾病(CMD)到1种CMD(OR=1.21,95%CI:1.08~1.36),从无CMD到CMM(OR=1.68,95%CI:1.41~2.01),从1种CMD到CMM(OR=1.74,95%CI:1.51~2.00)的风险均增加。在各年龄和性别组,以及居住在农村、低教育水平、非独居者中,有抑郁症状的中老年人发生CMM轨迹变化的风险均更高,均有统计学意义(P<0.05)。与没有抑郁症状者相比,有抑郁症状的独居者(OR=2.47,95%CI:1.70~3.60)比非独居者(OR=1.64,95%CI:1.41~1.90)发生CMM轨迹变化的风险效应值更高(交互作用P<0.05)。结论中国中老年人群中有抑郁症状者CMM发生轨迹变化的风险更高,应积极关注中老年人的心理健康状况,制定相应的干预措施,降低其对心血管代谢性疾病发生发展所造成的负担。

Objective To understand the correlation between depressive symptoms and cardiovascular-metabolic comorbidities(CMM)trajectories in Chinese residents(≥45 years old),and provide the basis for prevention and control and health management of CMM in middle-aged and elderly people.Methods Based on data from“the China Health and Retirement Longitudinal Study(CHARLS)in 2015 and 2018”,11182 middle-aged and older adults without CMM in 2015 served as the subjects.The investigation included the basic information,prevalence of chronic diseases and depression symptom measure.The information of CMM trajectories was from the data in 2018.The t test,Kruskal-Wallis H test,χ^(2) test and multi-nominal logit regression model were used to analyze the data.The used software was Stata 16.0.Results From 2015 to 2018,cardiometabolic disease(CMD)condition in 7736 cases of 11182 subjects(69.18%)did not change,1686 cases without CMD(15.08%)developed to one type of CMD,645 cases without CMD(5.77%)developed to CMM,and 1115 cases with one type CMD(9.97%)developed to CMM.The multinominal logit regression model analysis showed that as compared with subjects without depressive symptoms,the risk of developing from no CMD to one type of CMD(OR=1.21,95%CI:1.08-1.36),from no CMD to CMM(OR=1.68,95%CI:1.41-2.01),from one type of CMD to CMM(OR=1.74,95%CI:1.51-2.00)in subjects with depressive symptoms increased.The risk of CMM trajectory changes was higher in middle-aged and elderly people with depressive symptoms in all age and gender groups,as well as those living in rural areas,with low education level and non-cohabitation(P<0.05).As compared with the subjects with no depression symptoms,the risk of CMM trajectory changes in the subjects living alone with depression symptoms(OR=2.47,95%CI:1.70-3.60)were much higher than those in the subjects not living alone with depression symptoms(OR=1.64,95%CI:1.41-1.90),Pinteraction<0.05.Conclusion The risk of CMM trajectory changes in middle-aged and elderly people with depressive symptoms is much higher.It should pay attention to the mental health of middle-aged and elderly people,and should formulate the related intervention measures to reduce the disease burden of cardiovascular-metabolic comorbidities.