From the Department of Primary Care and Public Health (R.P., A.M.), Imperial College of London, UK; Department of Public Health (R.P.) and CIRMIS-Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (R.P.), University "Federico II" of Naples, Italy; Queen Square Multiple Sclerosis Centre (J.C.), Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, London, UK; and Departments of Medicine (R.A.M.) and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Neurology. 2021 Sep 28;97(13):e1322-e1333. doi: 10.1212/WNL.0000000000012610. Epub 2021 Sep 1.
To assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice-matched controls.
We conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.
We identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59-1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66-4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88-5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.
Depression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.
评估多发性硬化症（MS）患者的抑郁、血管疾病和死亡率之间的关联是否与年龄、性别和普通实践匹配的对照组不同。
我们进行了一项基于人群的回顾性匹配队列研究，纳入了 1987 年 1 月 1 日至 2018 年 9 月 30 日期间英格兰的 MS 患者和无 MS 的匹配对照者，按抑郁状态分层。我们使用时变 Cox 比例风险回归模型来检验 MS、抑郁与血管疾病和死亡率发生时间之间的关联。分析还按性别分层。
我们确定了 12251 名 MS 患者和 72572 名匹配对照者。在基线时，21%的 MS 患者和 9%的对照者有抑郁。与无抑郁的匹配对照者相比，无论是否伴有共病抑郁，MS 患者发生血管疾病的风险均增加。伴有抑郁的对照者的 10 年全因死亡率危险比为 1.75 倍（95%置信区间[CI]为 1.59-1.91），无抑郁的 MS 患者为 3.88 倍（95%CI 为 3.66-4.10），伴抑郁的 MS 患者为 5.43 倍（95%CI 为 4.88-5.96）。总体而言，MS 状态和抑郁之间的交互作用呈协同作用，观察到的效应的 14%归因于交互作用。性别分层分析证实了危险比的差异。
抑郁与 MS 患者发生血管疾病和死亡率的风险增加相关，抑郁和 MS 对全因死亡率的影响呈协同作用。进一步的研究应评估有效治疗抑郁是否与降低血管疾病和死亡率的风险相关。
