来自REGARDS研究的黑人和白人参与者全国队列中的抑郁症状与中风风险
Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS.
作者信息
Ford Cassandra D, Gray Marquita S, Crowther Martha R, Wadley Virginia G, Austin Audrey L, Crowe Michael G, Pulley LeaVonne, Unverzagt Frederick, Kleindorfer Dawn O, Kissela Brett M, Howard Virginia J
机构信息
Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB.
出版信息
Neurol Clin Pract. 2021 Aug;11(4):e454-e461. doi: 10.1212/CPJ.0000000000000983.
OBJECTIVE
The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.
METHODS
The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.
RESULTS
There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race ( = 0.53).
CONCLUSIONS
The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.
目的
本研究旨在探讨抑郁症状作为中风发病风险因素的情况，并确定抑郁症状在黑人和白人参与者中对中风的预测是否存在差异。
方法
该研究纳入了9529名年龄在45岁及以上的无中风黑人参与者和14516名无中风白人参与者，这些参与者均参与了中风地理和种族差异原因研究（2003 - 2007年）。中风发病是指首次发生中风。通过Cox比例风险模型分析基线抑郁症状（通过4项流行病学研究中心抑郁量表[CES - D - 4]评估：0、1 - 3或≥4）与中风发病之间的关联，并对人口统计学、中风风险因素和社会因素进行了调整。
结果
在平均9.21（标准差4.0）年的随访期间，共发生了1262例中风。与无抑郁症状的参与者相比，在进行人口统计学调整后，CES - D - 4评分为1 - 3的参与者中风风险增加了39%（风险比[HR] = 1.39，95%置信区间[CI] = 1.23 - 1.57），在进行全面调整后略有降低（HR = 1.27，95% CI = 1.11 - 1.43）。CES - D - 4评分≥4的参与者在人口统计学调整后中风风险高出54%（HR = 1.54，95% CI = 1.27 - 1.85），在完整模型中风险降低，与1 - 3症状的风险相似（HR = 1.25，95% CI = 1.03 - 1.51）。没有证据表明种族存在差异效应（P = 0.53）。
结论
在全国范围内的黑人和白人参与者样本中，抑郁症状与中风风险增加之间的关联相似。这些发现表明，在黑人和白人参与者的原发性中风预防中都应考虑对抑郁症状进行评估。
Zotero 插件