焦虑和抑郁与 COPD 队列死亡率的相关性。挪威 HUNT 研究。
The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway.
机构信息
Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway.
Clinic of Thoracic and Occupational Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
出版信息
Respir Med. 2020 Sep;171:106089. doi: 10.1016/j.rmed.2020.106089. Epub 2020 Aug 5.
BACKGROUND
Anxiety and depression are prevalent among individuals with chronic obstructive pulmonary disease (COPD), but the impact of these comorbidities on long-term mortality is unknown.
AIMS
This study aims to compare mortality in individuals with COPD who had or did not have symptoms of anxiety or depression as well as the impact of a change in these symptoms on mortality.
METHODS
Individuals with COPD according to the Global Lung Initiative (GLI) LLN criteria (n = 2076) were recruited from the second (1995-97) and third (2006-08) surveys of the HUNT Study and followed until January 2019 for mortality. We assessed baseline status of anxiety or depression using the Hospital Anxiety and Depression Scale (HADS), and probable cases were defined by a score ≥8. We used Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (CI). Change in HADS score over time was assessed using joint models.
RESULTS
Among the individuals with COPD, 16.2% had symptoms of anxiety and 15.9% had symptoms of depression. Compared to those with HADS-A and -D score <8, symptoms of anxiety or depression increased mortality by 21% (95% CI 05-47%) and 21% (2-44%), respectively. Over the approximately 11-year period between surveys, change of HADS-A from ≥8 to <8 was associated with a decrease in mortality (HR 0.97 [95% CI 0.94-1.00]), but not in HADS-D (0.97 [95% CI 0.93-1.18]).
CONCLUSIONS
Individuals with COPD and symptoms of anxiety or depression have increased mortality, and improved HADS-A score with time is associated with lower mortality.
背景
焦虑症和抑郁症在慢性阻塞性肺疾病（COPD）患者中较为常见，但这些合并症对长期死亡率的影响尚不清楚。
目的
本研究旨在比较有或没有焦虑或抑郁症状的 COPD 患者的死亡率，以及这些症状的变化对死亡率的影响。
方法
根据全球肺倡议（GLI）LLN 标准（n=2076），从 HUNT 研究的第二（1995-97 年）和第三（2006-08 年）次调查中招募 COPD 患者，并随访至 2019 年 1 月，以确定死亡率。我们使用医院焦虑和抑郁量表（HADS）评估基线时的焦虑或抑郁状态，得分≥8 定义为可能病例。我们使用 Cox 回归计算危险比（HR）和 95%置信区间（CI）。使用联合模型评估 HADS 评分随时间的变化。
结果
在 COPD 患者中，16.2%有焦虑症状，15.9%有抑郁症状。与 HADS-A 和 -D 评分<8 的患者相比，焦虑或抑郁症状使死亡率分别增加 21%（95%CI 05-47%）和 21%（2-44%）。在两次调查之间大约 11 年的时间里，HADS-A 从≥8 降至<8 与死亡率降低相关（HR 0.97[95%CI 0.94-1.00]），但 HADS-D 则不然（0.97[95%CI 0.93-1.18]）。
结论
COPD 患者有焦虑或抑郁症状，死亡率增加，HADS-A 评分随时间改善与死亡率降低相关。
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