Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
BMJ Open. 2021 Feb 16;11(2):e039628. doi: 10.1136/bmjopen-2020-039628.
Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study.
We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations.
Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26).
Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.
患有心理困扰的人群心血管疾病（CVD）的发病率较高。然而，这种关系是否具有因果关系尚不清楚，部分原因是存在方法学限制，包括与心理困扰的长期而不是单一时间点测量相关的证据有限。我们使用来自大规模队列研究的数据，比较了使用单一时间点和多时间点评估的心理困扰与 CVD 的相对风险。
我们使用问卷调查数据，该数据来自 CVD 无和癌症无的 45 岁及以上研究参与者，在两个时间点（时间 1：2006 年至 2009 年；时间 2：2010 年至 2015 年）收集，与住院和死亡记录相关联。随访期从时间 2 开始，截止到 2017 年 11 月 30 日。使用 Kessler 10（K10）在两个时间点测量心理困扰，允许评估单一时间点（时间 2：高（K10 评分：22-50）与低（K10 评分：<12））和多时间点（两个时间点的高困扰（K10 评分：22-50）与两个时间点的低困扰（K10 评分：<12））测量的困扰。Cox 回归量化了困扰与主要 CVD 之间的关联，包括调整社会人口统计学和与健康相关的特征，包括功能限制。
在 83906 名受访者中，在 410719 人年的随访中发生了 7350 例 CVD 事件（发生率：每 1000 人年 17.9 例）。与低困扰相比，多时间点（HR=1.63，95%CI 1.40 至 1.90）和单时间点（HR=1.53，95%CI 1.39 至 1.69）评估的高困扰人群的主要 CVD 年龄调整和性别调整发生率高出 50%-60%。当调整社会人口统计学和与健康相关的特征时，两种困扰评估的 HR 均减弱，当考虑到功能限制时，几乎没有关联的证据（多时间点 HR=1.09，95%CI 0.93 至 1.27；单时间点 HR=1.14，95%CI 1.02 至 1.26）。
无论使用单一时间点还是多时间点测量，困扰与 CVD 的关系在很大程度上可以用社会人口统计学特征和预先存在的与健康相关的因素来解释。
