Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
JAMA Netw Open. 2020 Feb 5;3(2):e1921043. doi: 10.1001/jamanetworkopen.2019.21043.
Depression is associated with increased disease burden worldwide and with higher risk of mortality in Western populations.
To investigate whether depression is a risk factor for all-cause and cardiovascular disease (CVD) mortality in adults in China.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study prospectively followed adults aged 30 to 79 years in the China Kadoorie Biobank (CKB) study from June 1, 2004, to December 31, 2016, and adults aged 32 to 104 years in the Dongfeng-Tongji (DFTJ) study from September 1, 2008, to December 31, 2016. Data analysis was conducted from June 1, 2018, to March 31, 2019.
Depression was evaluated using the Chinese version of the World Health Organization Composite International Diagnostic Interview-Short Form in the CKB cohort and a 7-item symptoms questionnaire modified from the Composite International Diagnostic Interview-Short Form in the DFTJ cohort. Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of depression with mortality. Covariates in the final models included sociodemographic characteristics, lifestyle factors, and personal and family medical history.
Among 512 712 individuals (mean [SD] age, 52.0 [10.7] years; 302 509 [59.0%] women) in the CKB cohort, there were 44 065 deaths, including 18 273 CVD deaths. The 12-month prevalence of major depressive episode in the CKB cohort was 0.64%, and the 1-month prevalence of clinically significant depressive symptoms was 17.96% in the DFTJ cohort. Among 26 298 individuals (mean [SD] age, 63.6 [7.8] years; 14 508 [55.2%] women) in the DFTJ cohort, there were 2571 deaths, including 1013 CVD deaths. In the multivariable-adjusted model, depression was associated with increased risk of all-cause mortality (CKB cohort: HR, 1.32 [95% CI, 1.20-1.46]; P < .001; DFTJ cohort: HR, 1.17 [95% CI, 1.06-1.29]; P = .002) and CVD mortality (CKB cohort: HR, 1.22 [95% CI, 1.04-1.44]; P = .02; DFTJ cohort: HR, 1.32 [95% CI, 1.14-1.54]; P < .001). In both cohorts, men had statistically significantly higher risk of all-cause mortality (CKB cohort: HR, 1.53 [95% CI, 1.32-1.76]; DFTJ cohort: HR, 1.24 [95% CI, 1.10-1.41]) and CVD mortality (CKB cohort: HR, 1.39 [95% CI, 1.10-1.76]; DFTJ cohort: HR, 1.49 [95% CI, 1.23-1.80]), while the association of depression with mortality among women was only significant for all-cause mortality in the CKB cohort (HR, 1.19 [95% CI, 1.03-1.37]).
These findings suggest that depression is associated with an increased risk of all-cause and CVD mortality in adults in China, particularly in men. These findings highlight the importance and urgency of depression management as a measure for preventing premature deaths in China.
抑郁症与全球疾病负担增加以及西方人群死亡率升高有关。
研究在中国成年人中，抑郁症是否是全因和心血管疾病（CVD）死亡率的一个危险因素。
设计、地点和参与者：这项队列研究前瞻性地随访了中国慢性病前瞻性研究（CKB）队列中年龄在 30 至 79 岁的成年人（2004 年 6 月 1 日至 2016 年 12 月 31 日）和东风-同济队列（DFTJ）中年龄在 32 至 104 岁的成年人（2008 年 9 月 1 日至 2016 年 12 月 31 日）。数据分析于 2018 年 6 月 1 日至 2019 年 3 月 31 日进行。
使用世界卫生组织综合国际诊断访谈-简短形式的中文版在 CKB 队列中评估抑郁，使用从综合国际诊断访谈-简短形式修改而来的 7 项症状问卷在 DFTJ 队列中评估抑郁。使用多变量调整的 Cox 比例风险回归模型来估计抑郁与死亡率之间的关联的危险比（HR）和 95%置信区间。最终模型中的协变量包括社会人口统计学特征、生活方式因素以及个人和家庭病史。
在 CKB 队列中，共有 512712 名参与者（平均[标准差]年龄，52.0[10.7]岁；302509[59.0%]为女性），其中有 44065 人死亡，包括 18273 例 CVD 死亡。在 CKB 队列中，12 个月主要抑郁发作的患病率为 0.64%，DFTJ 队列中 1 个月临床显著抑郁症状的患病率为 17.96%。在 DFTJ 队列中，共有 26298 名参与者（平均[标准差]年龄，63.6[7.8]岁；14508[55.2%]为女性），其中有 2571 人死亡，包括 1013 例 CVD 死亡。在多变量调整模型中，抑郁与全因死亡率（CKB 队列：HR，1.32[95%CI，1.20-1.46]；P<0.001；DFTJ 队列：HR，1.17[95%CI，1.06-1.29]；P=0.002）和 CVD 死亡率（CKB 队列：HR，1.22[95%CI，1.04-1.44]；P=0.02；DFTJ 队列：HR，1.32[95%CI，1.14-1.54]；P<0.001）的增加相关。在两个队列中，男性的全因死亡率（CKB 队列：HR，1.53[95%CI，1.32-1.76]；DFTJ 队列：HR，1.24[95%CI，1.10-1.41]）和 CVD 死亡率（CKB 队列：HR，1.39[95%CI，1.10-1.76]；DFTJ 队列：HR，1.49[95%CI，1.23-1.80]）的风险显著高于女性，而抑郁与女性全因死亡率的相关性仅在 CKB 队列中显著（HR，1.19[95%CI，1.03-1.37]）。
这些发现表明，在中国成年人中，抑郁症与全因和 CVD 死亡率的增加相关，特别是在男性中。这些发现强调了管理抑郁症作为预防中国过早死亡的重要性和紧迫性。
