Time-Varying Depressive Symptoms and Cardiovascular and All-Cause Mortality: Does the Risk Vary by Age or Sex?
Time-Varying Depressive Symptoms and Cardiovascular and All-Cause Mortality: Does the Risk Vary by Age or Sex?
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DOI：
10.1161/jaha.120.016661
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发表时间：
2020-10-20
影响因子：
5.4
通讯作者：
Moise N
中科院分区：
文献类型：
--
作者：
Bryant KB;Jannat-Khah DP;Cornelius T;Khodneva Y;Richman J;Fleck EM;Torres-Deas LM;Safford MM;Moise N
抑郁症状与死亡率有关。然而，关于年龄和性别对这种影响的缓和程度的数据并不一致。我们的目标是确定年龄和性别是否改变了抑郁症状与全因和心血管疾病(CVD)死亡率之间的关系。REAGES(中风中地理和种族差异的原因)研究是2003至2007年间招募的黑人和白人的前瞻性队列。使用调整人口统计学和临床危险因素的COX比例风险模型来衡量时变的抑郁症状(流行病学研究中心抑郁量表评分≥4分对4分)与全因和心血管疾病死亡率的关系。所有结果都按年龄或性别以及自我报告的健康状况进行分层。在29名491名参与者中，3253名(11%)有基线升高的抑郁症状。参与者的平均年龄为65岁(9.4岁)，其中55.1%为女性，41.1%为黑人，46.4%的人健康状况良好/非常好。抑郁症状在基线时被测量，平均4.9(SD，1.5)，然后是2.1(SD，0.4)。年龄和性别均不影响时变抑郁症状增加与全因或心血管疾病死亡率之间的关系(全因：年龄45-年调整危险比，1.38；95%CI，1.18-1.61对年龄≥65岁，1.36；95%CI，1.23-1.5；P=0.05；心血管疾病：45岁-岁，1.17；95%CI，0.90-1.53对年龄≥65岁，1.26；95%CI，1.06-1.5；P=0.54；全因：男性AHR 1.46；95%CI 1.29~1.64 vs女性1.34；95%CI 1.19~1.50；P=0.35；心血管疾病：男性AHR 1.32；95%CI 1.08~1.62 vs女性1.22；95%CI 1.00~1.47；P=0.64)。当按自我报告的健康状况分层时，也观察到了类似的结果。无论年龄和性别，抑郁症状都会带来死亡风险，包括报告健康状况良好/非常好的个人。
Depressive symptoms are associated with mortality. Data regarding moderation of this effect by age and sex are inconsistent, however. We aimed to identify whether age and sex modify the association between depressive symptoms and all‐cause and cardiovascular disease (CVD) mortality. The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort of Black and White individuals recruited between 2003 and 2007. Associations between time‐varying depressive symptoms (Center for Epidemiologic Studies Depression scale score ≥4 versus <4) and all‐cause and CVD mortality were measured using Cox proportional hazard models adjusting for demographic and clinical risk factors. All results were stratified by age or sex and by self‐reported health status. Of 29 491 participants, 3253 (11%) had baseline elevated depressive symptoms. Mean age was 65 (9.4) years, with 55.1% of participants female, 41.1% Black, and 46.4% had excellent/very good health. Depressive symptoms were measured at baseline, on average 4.9 (SD, 1.5), then 2.1 (SD, 0.4) years later. Neither age nor sex moderated the association between elevated time‐varying depressive symptoms and all‐cause or CVD mortality (all‐cause: age 45–64 years adjusted hazard ratio [aHR], 1.38; 95% CI, 1.18–1.61 versus age ≥65 years aHR,1.36; 95% CI, 1.23–1.50; P=0.05; CVD: age 45–64 years aHR, 1.17; 95% CI, 0.90–1.53 versus age ≥65 years aHR, 1.26; 95% CI, 1.06–1.50; P=0.54; all‐cause: males aHR, 1.46; 95% CI, 1.29–1.64 versus female aHR, 1.34; 95% CI, 1.19–1.50; P=0.35; CVD: male aHR, 1.32; 95% CI, 1.08–1.62 versus female aHR, 1.22; 95% CI, 1.00–1.47; P=0.64). Similar results were observed when stratified by self‐reported health status. Depressive symptoms confer mortality risk regardless of age and sex, including individuals who report excellent/very good health.