Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.
Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.
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墨西哥老年人口中抑郁症状升高和中风的风险。
DOI：
10.1111/jgs.16718
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Torres JM
中科院分区：
文献类型：
--
作者：
Meza E;Eng CW;Sáenz JL;Gilsanz P;Glymour MM;Torres JM
在高收入国家进行的几项纵向研究表明，抑郁症会增加中风的风险。然而，很少有先前的研究在低收入和中等收入国家（LMICs）评估这种关联，在这些国家，快速老龄化的人口可能具有明显不同的血管风险特征。前瞻性队列研究。墨西哥健康与老龄化研究是一项以墨西哥老年人为基础的全国性研究。2001年，共有10693名年龄在50岁及以上的墨西哥成年人参加了这项研究，他们没有中风史。2001年和2003年采用改良的9项流行病学研究中心抑郁量表（升高的抑郁症状临界值≥5）评估抑郁症状。我们使用Cox比例风险模型和应用反概率权重的敏感性分析，评估了2015年期间，抑郁症状升高（分为稳定低、近期缓解、近期发病或稳定高症状）的基线和短期（2年）变化与自述或近亲报告的医生诊断的中风事件之间的关系。在平均11.4年的随访中（标准差= 4.2），10693名受访者报告了546起中风事件。与基线抑郁症状升高的个体相比，基线抑郁症状升高的个体发生卒中的风险较高（风险比[HR] = 1.13； 95%可信区间[CI] = 0.95 - 1.36）。在对抑郁症状升高的短期变化（n = 8,808； 414例卒中事件）的分析中，近期发病（HR = 1.38; 95% CI = 1.06-1.81）或稳定的高抑郁症状升高（HR = 1.42; 95% CI = 1.10-1.84）的参与者与稳定的低抑郁症状/无抑郁症状的参与者相比，发生卒中的风险更大，而最近缓解（HR = 1.01; 95% CI = 0.74 - 1.37）的症状与卒中风险无关。减少抑郁症状的策略作为预防中等收入国家中风的方法值得评估。研究结果与高收入国家的结果相似，但应在其他中低收入国家复制。
Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. Prospective cohort study. The Mexican Health and Aging Study is a national population-based study of older adults in Mexico. A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke. Depressive symptoms were assessed with a modified 9-item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short-term (2-year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent-onset, or stable high symptoms) with incident self-reported or next-of-kin reported doctor-diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights. Over an average follow-up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95–1.36) compared with those without elevated baseline depressive symptoms. In analyses of short-term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent-onset (HR = 1.38; 95% CI = 1.06–1.81) or stable high (HR = 1.42; 95% CI = 1.10–1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74–1.37) symptoms was not associated with stroke hazard. Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle-income countries. Findings are similar to those in high-income countries but should be replicated in other LMICs.
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DOI：
10.1038/s41581-019-0244-2
发表时间：
2020-04
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Mills KT;Stefanescu A;He J
通讯作者：
He J
影响因子：
--
作者：
Irwin, M;Artin, KHH;Oxman, MN
通讯作者：
Oxman, MN
DOI：
10.1016/s0140-6736(17)32152-9
发表时间：
2017-09-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2016 Causes of Death Collaborators
通讯作者：
GBD 2016 Causes of Death Collaborators
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
10.5
作者：
Guerra, Mariella;Ferri, Cleusa P.;Prince, Martin
通讯作者：
Prince, Martin