Impairment in activities of daily living and cognitive decline mediate the association between depressive symptoms and incident hip fractures in Chinese older adults
Impairment in activities of daily living and cognitive decline mediate the association between depressive symptoms and incident hip fractures in Chinese older adults
复制标题
日常生活活动受损和认知能力下降介导中国老年人抑郁症状与髋部骨折之间的关联
DOI：
10.1016/j.bone.2022.116374
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发表时间：
2022-02-28
期刊：
影响因子：
4.1
通讯作者：
Huang，Shi-Shu
中科院分区：
文献类型：
--
作者：
Wu，Shuang;Shi，Hui;Huang，Shi-Shu
背景抑郁症状的出现与髋部骨折（HF）的风险增加有关。然而，很少有研究探讨中国老年人抑郁症状与高频发生之间的纵向关系，其潜在机制尚不清楚。以及认知功能和日常生活活动能力（ADL）障碍在中国老年人中的中介作用。一项基于队列的研究纳入了6336名基线时无HF病史且随访期间有完整数据的中国老年人（年龄范围，60-101岁）。离散时间考克斯回归用于评估抑郁症状与HF事件之间的关系，并进行自举多中介分析以检查认知功能和ADL损伤对该关联的影响。（3172例女性[50.1%];平均[SD]年龄，67.9 [6.6]岁），264例（4.2%）受试者发生HF。在调整年龄、性别、教育、婚姻状况、现居地、吸烟状况、饮酒状况、体重指数、慢性病次数和福尔斯跌倒史后，抑郁症状升高与HF风险增加独立相关（调整后风险比[aHR]：1.42; 95%CI：1.07 - 1.88）。然而，在调整认知功能和ADL损害后，这种关联不再显著（aHR：1.09; 95% CI：0.78 - 1.53）。当死亡率和HF事件被建模为一个复合结局时，在调整认知功能和ADL损害后，抑郁症状和联合结局之间的关联也保持不显著。此外，中介模型表明，认知能力下降（间接效应：β = 0.002，95% CI：0.001 - 0.003）和ADL受损（间接效应：β = 0.002，95% CI：0.000 - 0.003）在调整年龄、性别、福尔斯史后，和慢性疾病的数量。ConclusionsThe positive association between depression symptoms and incident HF was confirmed among Chinese older adults，which was completely mediated by cognitive decline and ADL impairment.这项研究揭示了抑郁症状在HF事件中的潜在作用。
BackgroundThe presence of depressive symptoms is associated with increasing risks of hip fractures (HFs). However, few studies investigated the longitudinal relationship between depressive symptoms and incident HFs among Chinese older adults, and the underlying mechanisms remain unclear.ObjectivesTo investigate the association between depressive symptoms and incident HFs, and the mediating role of cognitive function and impairment in activities of daily living (ADL) in the association among the older adults in China.MethodsThis population-based cohort study included 6336 Chinese older adults (age range, 60–101 years) without the history of HFs at baseline and with complete data during the follow-up. Discrete-time Cox regression was used to evaluate the relationship between depressive symptoms and incident HFs, and bootstrapped multiple mediation analyses were conducted to examine the effects of cognitive function and ADL impairment on the association.ResultsAmong 6336 participants (3172 women [50.1%]; mean [SD] age, 67.9 [6.6] years), 264 (4.2%) subjects had HFs onset. After adjusting for age, sex, education, marital status, current residence, smoking status, drinking status, body mass index, number of chronic conditions, and falls history, elevated depressive symptoms were independently associated with increasing risks of HFs (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.07 to 1.88). However, this association was no longer significant (aHR: 1.09; 95% CI: 0.78 to 1.53) after adjusting for cognitive function and ADL impairment. When mortality and incident HFs were modeled as a composite outcome, the association between depressive symptoms and combined outcomes also remained non-significant after adjusting for cognitive function and ADL impairment. Furthermore, the mediation model demonstrated that cognitive decline (indirect effect: β = 0.002, 95% CI: 0.001 to 0.003) and ADL impairment (indirect effect: β = 0.002, 95% CI: 0.000 to 0.003) fully mediated the association between depressive symptoms and incident HFs after adjusting for age, sex, falls history, and number of chronic conditions.ConclusionsThe positive association between depressive symptoms and incident HFs was confirmed among Chinese older adults, which was fully mediated by cognitive decline and ADL impairment. This study shed new light on the potential role played by depressive symptoms in incident HFs.