中东欧地区抑郁症状与心血管疾病及全因死亡率的关联：HAPIEE研究的前瞻性结果
The association of depressive symptoms with cardiovascular and all-cause mortality in Central and Eastern Europe: Prospective results of the HAPIEE study.
作者信息
Kozela Magdalena, Bobak Martin, Besala Agnieszka, Micek Agnieszka, Kubinova Ruzena, Malyutina Sofia, Denisova Diana, Richards Marcus, Pikhart Hynek, Peasey Anne, Marmot Michael, Pająk Andrzej
机构信息
Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
Department of Epidemiology and Public Health, University College London, London, UK.
出版信息
Eur J Prev Cardiol. 2016 Nov;23(17):1839-1847. doi: 10.1177/2047487316649493. Epub 2016 May 6.
BACKGROUND
Studies in western populations have shown a positive association between depression and cardiovascular disease (CVD) and all-cause mortality. The association with depressive symptoms seems to be graded, rather than limited to the presence versus the absence of depression. Evidence from populations with potentially different patterns of confounders helps to address the consistency of these findings. The objective of the study was to investigate the association between depressive symptoms and all-cause and CVD mortality in populations of Central and Eastern Europe.
STUDY DESIGN
This was a prospective cohort study.
METHODS
A total of 24,542 participants aged 45-69 years, randomly selected from populations of Novosibirsk (Russia), Krakow (Poland) and six Czech towns, were included. Depressive symptoms, assessed by the 20-item Center for Epidemiologic Studies Depression (CES-D) scale, were used as both continuous and categorical variables. Data on deaths were obtained from local or national death registers. Associations between depression and mortality were assessed using Cox proportional hazards models.
RESULTS
Over a median of 7 years, 2091 deaths from all causes and 850 CVD deaths occurred in the cohorts. There was a graded association between CES-D score and mortality; the hazard ratio (HR) of CVD mortality for a 1 SD increase in CES-D was 1.20 (95% confidence interval (CI): 1.16-1.24) in men and 1.23 (95% CI: 1.12-1.35) in women; for all-cause mortality, the HRs were 1.13 (95% CI: 1.09-1.18) and 1.17 (95% CI: 1.10-1.25), respectively. The results were similar across countries.
CONCLUSIONS
Depressive symptoms predicted CVD and all-cause mortality independently of a wide range of potential confounders. The association followed a gradient and increased mortality risks were associated with scores below the cut-offs that are commonly used to define 'depression'.
背景
西方人群的研究表明，抑郁症与心血管疾病（CVD）及全因死亡率之间存在正相关。与抑郁症状的关联似乎是分级的，而非仅限于是否存在抑郁症。来自混杂因素模式可能不同的人群的证据有助于检验这些发现的一致性。本研究的目的是调查中东欧人群中抑郁症状与全因死亡率及CVD死亡率之间的关联。
研究设计
这是一项前瞻性队列研究。
方法
共纳入了24542名年龄在45至69岁之间的参与者，他们是从新西伯利亚（俄罗斯）、克拉科夫（波兰）和捷克的六个城镇的人群中随机选取的。采用20项流行病学研究中心抑郁量表（CES-D）评估抑郁症状，并将其作为连续变量和分类变量使用。死亡数据来自当地或国家死亡登记册。使用Cox比例风险模型评估抑郁症与死亡率之间的关联。
结果
在中位时间为7年的随访期内，队列中发生了2091例全因死亡和850例CVD死亡。CES-D评分与死亡率之间存在分级关联；CES-D每增加1个标准差，男性CVD死亡率的风险比（HR）为1.20（95%置信区间（CI）：1.16 - 1.24），女性为1.23（95%CI：1.12 - 1.35）；对于全因死亡率，HR分别为1.13（95%CI：1.09 - 1.18）和1.17（95%CI：1.10 - 1.25）。各国的结果相似。
结论
抑郁症状独立于广泛的潜在混杂因素，可预测CVD和全因死亡率。这种关联呈梯度变化，死亡率增加的风险与通常用于定义“抑郁症”的临界值以下的分数相关。
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