中老年人抑郁症状发展轨迹与跌倒及跌伤的关联性分析

Association between Trajectories of Depressive Symptoms with Falls and Fall-related Injuries in China

目的识别并划分中国中老年人群抑郁症状的发展轨迹,并探究不同抑郁轨迹与跌倒及跌伤的关联。方法基于中国健康与养老追踪调查研究(CHARLS)的五波数据,利用组基轨迹模型识别10254名45岁及以上中老年人2011—2018年的抑郁症状发展轨迹,并采用修正的泊松回归分析不同抑郁轨迹与2020年跌倒及跌伤结局的关联性。结果识别并划分出“无抑郁风险组”(3158,31.81%)、“潜在抑郁风险组”(4463,40.28%)、“抑郁出现组”(994,10.93%)、“抑郁缓解组”(1067,11.36%)和“持续高抑郁组”(572,5.62%)5种抑郁轨迹。修正的泊松回归结果表明,与“无抑郁风险组”相比,其他轨迹类型跌倒和跌伤风险显著升高(P值均<0.05)。在调整了年龄、性别、婚姻状况、教育、吸烟、饮酒、用药数量、慢性病数量和社会活动得分后,“潜在抑郁风险组”“抑郁出现组”“抑郁缓解组”和“持续高抑郁组”的跌倒校正RR分别为1.27(95%CI:1.14,1.43)、1.73(95%CI:1.49,2.00)、1.78(95%CI:1.54,2.05)和2.25(95%CI:1.93,2.63),跌伤的多因素校正RR分别为1.42(95%CI:1.14,1.78)、2.24(95%CI:1.70,2.96)、2.41(95%CI:1.77,3.26)和3.13(95%CI:2.28,4.30)。结论中国中老年人异质性抑郁轨迹可划分为五类,不同中老年人抑郁轨迹类别与跌倒及跌伤的结果之间存在着显著的相关性。根据不同抑郁轨迹及特点,制定并采取针对性措施,可能有助于降低中老年人群跌倒及跌伤风险。

Objective To identify different trajectories of depressive symptoms in middle-aged and elderly Chinese citizens,especially with falls and fall-related injuries.Methods Utilizing five waves of data from the China Health and Retirement Longitudinal Study(CHARLS),group-based trajectory model was used to identify trajectories of depressive symptoms in 10254 older adults over 45 years old,and adjusted Poisson regression was used to analyze associations between different depressive trajectories and falls and fall-related injuries in 2020.Results Five depressive trajectories were identified as"No Risk of Depression"(n=3158,31.81%),"Potential Risk of Depression"(n=4463,40.28%),"Emerging Depressive Symptoms"(n=994,10.93%),"Remiting Depressive Symptoms"(n=1067,11.36%)and"Persistent High Depression"(n=572,5.62%).Adjusted Poisson regression results indicated that compared to the"No Risk of Depression"group,all other trajectories showed significantly elevated risks of falls and fall-related injuries(P<0.05).After adjusting for age,gender,marital status,education,smoking,alcohol consumption,number of medications,number of chronic diseases,and social activity scores,the adjusted RR for falls in the"Potential Risk of Depression","Emerging Depressive Symptoms","Remitting Depressive Symptoms"and"Persistent High Depression"groups were 1.27(95%CI:1.14,1.43),1.73(95%CI:1.49,2.00),1.78(95%Cl:1.54,2.05)and 2.25(95%CI:1.93,2.63),respectively.The adjusted RR for fall-related injuries were 1.42(95%CI:1.14,1.78),2.24(95%CI:1.70,2.96),2.41(95%Cl:1.77,3.26)and 3.13(95%Cl:2.28,4.30),respectively.Conclusion Heterogeneous depressive trajectories among Chinese middle-aged and elderly were identified and grouped into five categories,and depressive trajectories were associated with falls and fall-related injuries.Attention needs to be directed towards distinct depressive trajectories and characteristics,for enhancing protocols to reduce risk of falls and fall-related injuries.