中国中老年人抑郁和慢性病的关联

doi:10.19723/j.issn.1671-167X.2023.04.006

摘要/Abstract

摘要：

目的: 了解我国中老年人抑郁和慢性病的关联。方法: 利用我国健康与养老追踪调查(China health and retirement longitudinal study，CHARLS)2011年基线数据，纳入10 420名45岁及以上的中老年人，收集研究对象的人口学资料、生活习惯和慢性病患病情况。抑郁症状采用10条目的流调中心抑郁量表(10-item version of center for epidemiological studied depression，CESD-10)测量, CESD-10评分≥10定义为有抑郁症状。采用多因素Logistic回归模型分析抑郁症状和慢性病的关联。结果: 纳入的10 420名研究对象的平均年龄为(59.2±9.4)岁，48.2%为男性，其中3 900名(37.4%)中老年人有抑郁症状。多因素Logistic回归分析结果显示，在调整所有潜在混杂因素以后，抑郁症状和糖尿病(OR=1.230，95%CI: 1.080~1.401)、高血压(OR=1.335，95%CI: 1.205~1.480)、心脏病(OR=1.953，95%CI: 1.711~2.229)、脑卒中(OR=2.269，95%CI: 1.704~3.020)均有关联(P < 0.05)，而未发现血脂异常和抑郁症状之间存在显著关联(P>0.05)，随着共患慢性病数量的增加，抑郁症状的患病率也随之升高(P_trend < 0.001)。结论: 我国中老年人抑郁症状和慢性病有关联，未来需要在前瞻性研究中进一步探究二者是否有因果关系。

关键词: 中老年人, 抑郁症状, 慢性病, 横断面研究

Abstract:

Objective: To examine the association between depressive symptoms and chronic diseases among middle-aged and older Chinese adults within a national investigation. Methods: Data used in current analysis were obtained from a nationally representative, cross-sectional population-based survey of China health and retirement longitudinal study, which were conducted in 2011 using four-stage probability-proportional-to-size sampling methods. A total of 10 420 participants who were aged 45 years and above from 28 provinces in mainland China were included. Information on demographic characteristics (e.g., age, gender, education level), lifestyle factors (e.g., smoking status and drinking frequency) and chronic diseases (e.g., hypertension, diabetes, and stroke) were collected by well-trained interviewers at the interviewees' homes using a standardized questionnaire. Depressive symptoms were measured using the 10-item version of the center for epidemiological studies depression scale (CESD-10, which was a widely used standard tool in Chinese population, and elevated depressive symptoms were defined by a cut-off ≥10. Multivariate Logistic regression analysis was carried out to assess the association between depressive symptoms and chronic diseases (including hypertension, diabetes, heart disease, dyslipidemia and stroke), adjusting for age, gender, education level, marital status, ethnicity, place of residence, bady mass index (BMI) and other potential confounding factors. Results: Among the 10 420 participants, the mean age was (59.2±9.4) years, and 48.2% of them were men. There were 3 900 (37.4%) participants who had a depression rating score of 10 or greater, indicative of elevated depressive symptoms. The results of multivariate Logistic regression analysis demonstrated that diabetes (OR=1.230, 95%CI: 1.080-1.401), hypertension (OR=1.335, 95%CI: 1.205-1.480), heart disease (OR=1.953, 95%CI: 1.711-2.229), and stroke (OR=2.269, 95%CI: 1.704-3.020) were significantly associated with depressive symptoms (P < 0.05), after full adjustment of age, gender, education level, marital status, ethnicity, residency and other potential confounders. While no significant relationship was found between dyslipidemia and depressive symptoms (P>0.05). The prevalence of elevated depressive symptoms increased parallel with the number of chronic diseases (P_trend < 0.001). Conclusion: Depressive symptoms were significantly associated with chronic diseases (including diabetes, hypertension, heart disease, and stroke), which suggests that psychological factors, such as depressive symptoms should be taken into consideration in the prevention and control of chronic diseases.

Key words: Middle-aged and older population, Depressive symptoms, Chronic diseases, Cross-sectional study

中图分类号:

R181.3

祝春素,连至炜,崔一民. 中国中老年人抑郁和慢性病的关联[J]. 北京大学学报（医学版）, 2023, 55(4): 606-611.

Chun-su ZHU,Zhi-wei LIAN,Yi-min CUI. Association between depression and chronic diseases among middle-aged and older Chinese adults[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 606-611.

图/表 4

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Characteristics	Full sample(n=10 420)	Depression disorder		P value
Characteristics	Full sample(n=10 420)	No (n=6 520)	Yes (n=3 900)	P value
Age/years, $\bar x \pm s$	59.2±9.4	58.7±9.3	60.0±9.4	<0.001
Gender, n (%)				<0.001
Male	5 018 (48.2)	3 484 (53.4)	1 534 (39.3)
Female	5 402 (51.8)	3 036 (46.6)	2 366 (60.7)
Residence, n (%)				<0.001
Urban	3 675 (35.3)	2 554 (39.2)	1 121 (28.7)
Rural	6 745 (64.7)	3 966 (60.8)	2 779 (71.3)
Education, n (%)				<0.001
Primary school and below	7 128 (68.4)	4 073 (62.5)	3 055 (78.3)
Middle school	2 182 (20.9)	1 560 (23.9)	622 (15.9)
High school	940 (9.0)	741 (11.4)	199 (5.1)
Above high school	170 (1.6)	146 (2.2)	24 (0.6)
Ethnicity, n (%)				0.275
Han	9 971 (95.7)	6 250 (95.9)	3 721 (95.4)
Others	449 (4.3)	270 (4.1)	179 (4.6)
Marital status, n (%)				<0.001
Married	9 159 (87.9)	5 903 (90.5)	3 256 (83.5)
Separated or divorced or never married	209 (2.0)	92 (1.4)	117 (3.0)
Widowed	1 052 (10.1)	525 (8.1)	527 (13.5)
BMI /(kg/m²)，$\bar x \pm s$	23.5±3.9	23.8±4.0	23.1±3.8	<0.001
Sleep duration, n (%)				<0.001
<6 h	3 051 (29.3)	1 343 (20.6)	1 708 (43.8)
6-8 h	6 519 (62.6)	4 596 (70.5)	1 923 (49.3)
≥8 h	850 (8.2)	581 (8.9)	269 (6.9)
Smoking, n (%)				<0.001
Current	3 252 (31.2)	2162 (33.2)	1 090 (27.9)
Never	6 212 (59.6)	3707 (56.9)	2 505 (64.2)
Past	956 (9.2)	651 (10.0)	305 (7.8)
Alcohol use, n (%)				<0.001
Never	6 968 (66.9)	4 139 (63.5)	2 829 (72.5)
Less than once a month	825 (7.9)	551 (8.5)	274 (7.0)
At least once a month	2 627 (25.2)	1 830 (28.1)	797 (20.4)

Characteristics	Full sample(n=10 420)	Depression disorder		P value	OR
Characteristics	Full sample(n=10 420)	No (n=6 520)	Yes (n=3 900)	P value	OR
Diabetes, n (%)				0.049
No	9 179 (88.1)	5 775 (88.6)	3 404 (87.3)		1 (ref)
Yes	1 241 (11.9)	745 (11.4)	496 (12.7)		1.130 (1.001-1.275)
Hypertension, n (%)				<0.001
No	7 935 (76.2)	5 067 (77.7)	2 868 (73.5)		1(ref)
Yes	2 485 (23.8)	1 453 (22.3)	1 032 (26.5)		1.255 (1.145-1.376)
Heart disease, n (%)				<0.001
No	9 234 (88.6)	5 941 (91.9)	3 293 (84.4)		1(ref)
Yes	1 186 (11.4)	579 (8.9)	607 (15.6)		1.891 (1.675-2.136)
Stroke, n (%)				<0.001
No	10 197 (97.9)	6 420 (98.5)	3 777 (96.8)		1(ref)
Yes	223 (2.1)	100 (1.5)	123 (3.2)		2.091 (1.601-2.730)
Dyslipidemia, n (%)				0.307
No	6 915 (66.4)	4 303 (66.0)	2 612 (67.0)		1(ref)
Yes	3 505 (33.6)	2 217 (34.0)	1 288 (33.0)		0.957 (0.880-1.041)
Number of comorbid chronic disease				<0.001
0	4 898 (47.0)	3 178 (48.7)	1 720 (44.1)		1(ref)
1	3 284 (31.5)	2 049 (31.4)	1 235 (31.7)		1.114 (1.016-1.221)
2	1 518 (14.6)	914 (14.0)	604 (15.5)		1.221 (1.085-1.374)
≥3	720 (6.9)	379 (5.8)	341 (8.7)		1.662 (1.420-1.946)

Items	Model 1	Model 2
Diabetes
No	1 (ref)	1 (ref)
Yes	1.097 (0.970-1.241)	1.230 (1.080-1.401)
Hypertension
No	1 (ref)	1 (ref)
Yes	1.158 (1.054-1.272)	1.335 (1.205-1.480)
Heart disease
No	1 (ref)	1 (ref)
Yes	1.735 (1.533-1.963)	1.953 (1.711-2.229)
Stroke
No	1 (ref)	1 (ref)
Yes	2.031 (1.549-5.661)	2.269 (1.704-3.020)
Dyslipidemia
No	1 (ref)	1 (ref)
Yes	0.930 (0.854-1.013)	1.025 (0.935-1.123)
Number of comorbid chronic disease
0	1 (ref)	1 (ref)
1	1.070 (0.974-1.174)	1.167 (1.057-1.288)
2	1.113 (0.986-1.256)	1.335 (1.171-1.523)
≥3	1.518 (1.293-1.781)	2.052 (1.721-2.447)
P_trend	<0.001	<0.001

Items	45-59	60-74	≥75
Diabetes
No	1 (ref)	1 (ref)	1 (ref)
Yes	1.182 (0.980-1.425)	1.242 (1.018-1.515)	1.434 (0.891-2.309)
Hypertension
No	1 (ref)	1(ref)	1 (ref)
Yes	1.434 (1.229-1.672)	1.269 (1.089-1.479)	1.206 (0.852-1.707)
Heart disease
No	1 (ref)	1(ref)	1 (ref)
Yes	2.066 (1.689-2.528)	1.902(1.568-2.306)	1.943 (1.226-3.079)
Stroke
No	1 (ref)	1 (ref)	1 (ref)
Yes	2.627 (1.640-206)	2.234 (1.492-3.345)	1.679 (0.718-3.927)
Dyslipidemia
No	1 (ref)	1 (ref)	1 (ref)
Yes	1.057 (0.931-1.200)	0.970 (0.839-1.121)	1.055 (0.739-1.507)