The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.
The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.
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DOI：
10.1186/1741-7015-11-250
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发表时间：
2013-11-26
期刊：
影响因子：
9.3
通讯作者：
Whiteford HA
中科院分区：
文献类型：
--
作者：
Charlson FJ;Moran AE;Freedman G;Norman RE;Stapelberg NJ;Baxter AJ;Vos T;Whiteford HA
心血管疾病和精神健康都具有巨大的公共卫生重要性，在最近的《2010年全球疾病负担研究》（GBD 2010）的结果中，两者都排名很高。GBD 2010首次采用比较风险评估方法系统、定量地评估重度抑郁症作为缺血性心脏病（IHD）发展的独立危险因素。综合相对危险度（RR）是通过系统评价确定的研究计算出来的，系统评价采用严格的纳入标准，旨在提供独立危险因素状态的证据。公认的抑郁症病例定义包括由临床医生或非临床医生评估者根据精神疾病诊断与统计手册（DSM）或国际疾病分类（ICD）分类进行诊断。因此，我们将本文中的暴露称为重度抑郁症，而不是DSM-IV的重度抑郁症（MDD）类别。总体归因分数（PAF）采用合并RR估计计算。归属负担的计算方法是将PAF乘以作为GBD 2010的一部分估计的IHD潜在负担。重度抑郁症患者发生IHD的总相对危险度为1.56 （95% CI 1.30 ~ 1.87）。全球估计有近400万IHD残疾调整生命年（DALYs），可归因于2010年的重度抑郁症；失去了350万年的生命，25万年的生命是残疾的。这些发现强调了先前被低估的重性抑郁症的死亡率。作为IHD总负担的一部分，2010年估计有2.95% （95% CI 1.48 - 4.46%）的IHD残疾死亡年可归因于MDD。东欧和北非/中东的比例最高，亚太地区的比例最低。目前的工作包括迄今为止同类研究中最有力的系统综述。重度抑郁症可能占全球IHD死亡时间的约3%，这一关键发现值得对发生IHD高风险或有重复IHD事件风险的患者的抑郁症进行评估。
Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology. A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010. The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest. The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.
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