中国中老年人群抑郁症状、缺血性心血管疾病10年风险对心血管疾病的联合影响

doi:10.19723/j.issn.1671-167X.2023.03.012

摘要/Abstract

摘要：

目的: 探讨抑郁症状与缺血性心血管疾病10年风险对心血管疾病(cardiovascular disease, CVD)发生的联合影响。方法: 基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据库中的2011年基线数据和2013年、2015年、2018年随访队列数据，对2011年基线抑郁症状、缺血性心血管疾病10年风险分布特征进行描述，采用Cox生存分析模型分析抑郁症状和缺血性心血管疾病10年风险对CVD的单独、独立和联合关联。结果: 共纳入研究对象9 412例，基线抑郁症状检出率为44.7%，缺血性心血管疾病10年中高风险比例为13.62%。平均随访6.19(6.19±1.66)年中，总计观察58 258人年，1 401例中老年人发生了心血管疾病，发病密度为24.048/千人年。调整因素后，单独影响中，有抑郁症状者的CVD发生危险高(HR=1.263，95%CI: 1.133~1.408)，缺血性心血管疾病10年中高风险者的CVD发生危险高(HR=1.892，95%CI: 1.662~2.154)。独立影响因素中，有抑郁症状者CVD发生危险高(HR=1.269，95%CI: 1.138~1.415)，缺血性心血管疾病10年中高风险者的CVD发生危险高(HR=1.898，95%CI: 1.668~2.160)。联合影响结果显示有抑郁症状且缺血性心血管疾病10年低风险、无抑郁症状且缺血性心血管疾病10年中高风险、抑郁症状合并缺血性心血管疾病10年中高风险人群发生CVD分别是无抑郁症状且缺血性心血管疾病10年低风险人群的1.390、2.149、2.339倍(P < 0.001)。结论: 缺血性心血管疾病10年中高风险人群叠加抑郁症状会加剧中老年人心血管疾病发生的风险，结合实际开展生活方式干预和生理指标健康管理的同时，应重视中老年人群的心理健康干预。

关键词: 抑郁症状, 缺血性心血管病, 心血管疾病, 联合影响

Abstract:

Objective: To explore joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease (CVD) in middle-aged and elderly people in China. Methods: Based on China Health and Retirement Longitudinal Study(CHARLS)database using 2011 baseline data and the follow-up cohort data of 2013, 2015 and 2018, describe the distribution characteristics of baseline depressive symptoms and 10-year risk of ischemic cardiovascular disease in 2011. Cox survival analysis model was used to analyze the individual, independent and joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease with cardiovascular disease. Results: A total of 9 412 subjects were enrolled. The detection rate of depressive symptoms at baseline was 44.7%, and the 10-year middle and high risk of ischemic cardiovascular disease was 13.62%. During an average follow-up of 6.19 (6.19±1.66) years, 1 401 cases of cardiovascular disease were diagnosed in 58 258 person-years, revealing an overall incidence density of 24.048/1 000 person-years. After adjusting the factors, in terms of individual impact, the participants with depressive symptoms had a higher risk of developing CVD (HR=1.263, 95%CI: 1.133-1.408), while medium to high risk of ischemic cardiovascular disease had a higher risk of developing CVD (HR=1.892, 95%CI: 1.662-2.154). Among independent influences, participants with depressive symptoms had a higher risk of developing CVD (HR=1.269, 95% CI: 1.138-1.415), while medium to high risk of 10-year risk of ischemic cardiovascular disease had a higher risk of developing CVD (HR=1.898, 95%CI: 1.668-2.160). Joint impact result showed the incidence of cardiovascular disease in the low risk of 10-year risk of ischemic cardiovascular disease with depressive symptoms group, middle and high risk of 10-year risk of ischemic cardiovascular disease without depressive symptoms group, and 10-year middle and high risk of ischemic cardiovascular disease with depressive symptoms group were 1.390, 2.149, and 2.339 times higher than that of low risk of 10-year risk of ischemic cardiovascular disease without depressive symptoms (P < 0.001). Conclusion: The superimposed depression symptoms of the middle and high-risk population at the 10-year risk of ischemic cardiovascular disease will aggravate the risk of cardiovascular disease in middle-aged and elderly people. In combination with the actual lifestyle intervention and physical index health management, attention should be paid to mental health intervention.

Key words: Depressive symptoms, Ischemic cardiovascular disease, Cardiovascular disease, Joint association

中图分类号:

R193.3

张紫薇,花语蒙,刘爱萍. 中国中老年人群抑郁症状、缺血性心血管疾病10年风险对心血管疾病的联合影响[J]. 北京大学学报（医学版）, 2023, 55(3): 465-470.

Zi-wei ZHANG,Yu-meng HUA,Ai-ping LIU. Joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease with the cardiovascular disease in middle-aged and elderly people in China[J]. Journal of Peking University (Health Sciences), 2023, 55(3): 465-470.

图/表 4

表1

基线抑郁症状与ICVD风险的人群分布特征"

Characteristics	n	Depressive symptoms				ICVD risk level
Characteristics	n	No, n(%)	Yes, n(%)	χ²	P	Low risk, n(%)	Moderately-high-risk, n(%)	χ²	P
Age/years
45-	3 734	2 114 (56.61)	1 620 (43.39)	7.186	0.066	3 552 (95.13)	182 (4.87)	483.120	< 0.001
55-	3 451	1 906 (55.23)	1 545 (44.77)			2 886 (83.63)	565 (16.37)
65-	1 644	883 (53.71)	761 (46.29)			1 275 (77.55)	369 (22.45)
75-	583	302 (51.80)	281 (48.20)			417 (71.53)	166 (28.47)
Gender
Male	4 526	2 819 (62.3)	1 707 (37.7)	171.980	< 0.001	4 058 (89.7)	468 (10.3)	79.753	< 0.001
Female	4 886	2 386 (48.8)	2 500 (51.2)			4 072 (83.3)	814 (16.7)
Area
Rural	5 846	3 048 (52.1)	2 798 (47.9)	62.470	< 0.001	5 088 (87.0)	758 (13.0)	5.623	0.018
Urban	3 566	2 157 (60.5)	1 409 (39.5)			3 042 (85.3)	524 (14.7)
Education
Primary school and below	6 181	3 156 (51.1)	3 025 (48.9)	166.770	< 0.001	5 193 (84.0)	988 (16.0)	85.914	< 0.001
Junior middle school	1 999	1 189 (59.5)	810 (40.5)			1 811 (90.6)	188 (9.4)
Senior high school	995	683 (68.6)	312 (31.4)			909 (91.4)	86 (8.6)
Junior college and above	237	177 (74.7)	60 (25.3)			217 (91.6)	20 (8.4)
Marital status
Married	8 312	4 726 (56.9)	3 586 (43.1)	69.640	< 0.001	7 289 (87.7)	1 023 (12.3)	104.274	< 0.001
Divorced/unmarried/widowed	1 100	479 (43.5)	621 (56.5)			841 (76.5)	259 (23.5)
Smoking status
Never	5 687	2 972 (52.3)	2 715 (47.7)	57.170	< 0.001	4 898 (86.1)	789 (13.9)	18.889	< 0.001
Quit	719	453 (63.0)	266 (37.0)			659 (91.7)	60 (8.3)
Smoke	3 006	1 780 (59.2)	1 226 (40.8)			2 573 (85.6)	433 (14.4)
Disability
No	9 111	5 081 (55.8)	4 030 (44.2)	25.029	< 0.001	7 868 (86.4)	1 243 (13.6)	0.117	0.733
Yes	301	124 (41.2)	177 (58.8)			262 (87.0)	39 (13.0)
BMI/(kg/m²)
Normal	5 065	2 792 (55.1)	2 273 (44.9)	27.339	< 0.001	4 659 (92.0)	406 (8.0)	618.576	< 0.001
Lighter	586	267 (45.6)	319 (54.4)			534 (91.1)	52 (8.9)
Overweight	2 711	1 551 (57.2)	1 160 (42.8)			2 267 (83.6)	444 (16.4)
Obesity	1 050	595 (56.7)	455 (43.3)			670 (63.8)	380 (36.2)
Sleep
≥6 h	6 865	4 266 (62.1)	2 599 (37.9)	480.087	< 0.001	5 969 (86.9)	896 (13.1)	6.986	0.008
< 6 h	2 547	939 (36.9)	1 608 (63.1)			2 161 (84.8)	386 (15.2)
Hypertension
No	5 958	3 281 (55.1)	2 677 (44.9)	0.356	0.551	5 856 (98.3)	102 (1.7)	1 956.999	< 0.001
Yes	3 454	1 924 (55.7)	1 530 (44.3)			2 274 (65.8)	1 180 (34.2)
Diabetes
No	7 254	3 996 (55.1)	3 258 (44.9)	0.591	0.442	6 667 (91.9)	587 (8.1)	821.975	< 0.001
Yes	2 158	1 209 (56.0)	949 (44.0)			1 463 (67.8)	695 (32.2)
Dyslipidemia
No	6 793	3 784 (55.7)	3 009 (44.3)	1.601	0.206	6 046 (89.0)	747 (11.0)	142.896	< 0.001
Yes	2 619	1 421 (54.3)	1 198 (45.7)			2 084 (79.6)	535 (20.4)

表1

表2

图1

表3

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Characteristics	n	Person-years of observations	Cases of CVD, n	Incidence density/per 1 000 person-years (95%CI)
Depressive symptoms
No	5 205	32 421	693	21.375 (19.25-23.735)
Yes	4 207	25 837	708	27.403 (24.678-30.428)
ICVD risk level
Low risk	8 130	50 681	1 099	21.685 (19.092-24.630)
Moderately-high-risk	1 282	7 577	302	39.857 (35.092- 45.270)

Characteristics	n	CVD, n	Crude HR (95%CI)	Adjust HR^a (95%CI)	Adjust HR^b (95%CI)
Individual impact
Depressive symptoms
No	5 205	693	1.000
Yes	4 207	708	1.301(1.172-1.445)^*	1.314(1.182-1.461)^*	1.263(1.133-1.408)^*
ICVD risk level
Low risk	8 130	1 099	1.000
Moderately-high-risk	1 282	302	1.928(1.697-2.190)^*	1.899(1.669-2.161)^*	1.892(1.662-2.154)^*
Independent influence
Depressive symptoms
No	5 205	693	1.000
Yes	4 207	708	1.295(1.167-1.438)^*	1.318(1.186-1.466)^*	1.269(1.138-1.415)^*
ICVD risk level
Low risk	8 130	1 099	1.000
Moderately-high-risk	1 282	302	1.922(1.692-2.183)^*	1.904(1.673-2.167)^*	1.898(1.668-2.160)^*
Interactive item
Depressive symptoms×ICVD risk level			0.793(0.615-1.025)^#	0.783(0.607-1.011)^#	0.778(0.602-1.004)^#
Joint influence
Depression symptoms and ICVD risk
No depressive symptoms and low risk of ICVD	4 499	533	1.000
Symptoms of depression and low risk of ICVD	3 631	566	1.361(1.210-1.532)^*	1.339(1.185-1.512)^*	1.390(1.233-1.566)
No depressive symptoms and medium to high risk of ICVD	706	160	2.09(1.806-2.571)^*	2.149(1.799-2.567)^*	2.149(1.799-2.567)^*
Depression symptoms combined with high risk of ICVD	576	142	2.329(1.935-2.802)^*	2.239(1.850-2.710)^*	2.339(1.936-2.825)^*