Department of Epidemiology,Gillings School of Global Public Health,University of North Carolina at Chapel Hill,USA.
Department of Nutrition,Gillings School of Global Public Health,University of North Carolina at Chapel Hill,USA.
Br J Psychiatry. 2019 Aug;215(2):449-455. doi: 10.1192/bjp.2019.74. Epub 2019 Apr 10.
Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.
We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.
A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.
Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.
老年期抑郁症已成为一个重要的公共卫生问题。现有证据表明，老年期抑郁症与社区中老年人的全因死亡率和心血管死亡率相关，尽管这些关联尚未得到全面审查和量化。目的：评估社区居住的老年人中晚年抑郁症与全因和心血管死亡率的综合关联。
我们对前瞻性队列研究进行了系统评价和荟萃分析，这些研究检查了晚年抑郁症与社区环境中全因和心血管死亡率的关联。
共有 61 项前瞻性队列研究来自 53 个队列，共有 198589 名参与者纳入了系统评价和荟萃分析。共有 49 个队列报告了全因死亡率，15 个队列报告了心血管死亡率。晚年抑郁症与全因死亡率（风险比 1.34；95%置信区间 1.27，1.42）和心血管死亡率（风险比 1.31；95%置信区间 1.20，1.43）的风险增加相关。研究之间的结果存在异质性，并且关联的大小因年龄、性别、研究地点、随访时间以及评估抑郁症的方法而有所不同。这些关联在不同的年龄、性别、研究区域、随访期和晚年抑郁症评估方法的亚组中存在。
晚年抑郁症与社区居住的老年人全因和心血管死亡率的风险增加相关。未来的研究需要测试预防老年人抑郁症的有效性，作为降低该人群死亡率的一种方法。晚年抑郁症的最佳治疗及其对死亡率的影响需要进一步研究。
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