Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que.
CMAJ Open. 2022 Jun 14;10(2):E508-E518. doi: 10.9778/cmajo.20210019. Print 2022 Apr-Jun.
A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada.
We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin A level was 7% or more; we defined participants as having depression if their Center for Epidemiological Studies Depression score was 10 or higher or if they were currently undergoing depression treatment. We excluded those with baseline depression (Cohort 1) and baseline diabetes (Cohort 2) to evaluate the associations between diabetes and depression incidence, and between depression and diabetes incidence, respectively. We constructed logistic regression models with interaction by immigrant status.
Cohort 1 ( = 20 723; mean age 62.7 yr, standard deviation [SD] 10.1 yr; 47.6% female) included 3766 (18.2%) immigrants. Among immigrants, 16.4% had diabetes, compared with 15.6% among nonimmigrants. Diabetes was associated with an increased risk of depression in nonimmigrants (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.08-1.49), but not in immigrants (adjusted OR 1.12, 95% CI 0.80-1.56). Younger age, female sex, weight change, poor sleep quality and pain increased depression risk. Cohort 2 ( = 22 054; mean age 62.1 yr, SD 10.1 yr; 52.2% female) included 3913 (17.7%) immigrants. Depression was associated with an increased risk of diabetes in both nonimmigrants (adjusted OR 1.39, 95% CI 1.16-1.68) and immigrants (adjusted OR 1.60, 95% CI 1.08-2.37). Younger age, male sex, waist circumference, weight change, hypertension and heart disease increased diabetes risk.
We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.
抑郁和糖尿病之间存在双向关联，但尚未在移民身份背景下进行评估。鉴于健康的社会决定因素在移民和非移民之间存在差异，我们评估了糖尿病和抑郁发病率、抑郁和糖尿病发病率之间的关联，以及移民身份是否改变了这种关联，在加拿大的移民和非移民中。
我们采用回顾性队列设计，使用加拿大老龄化纵向研究综合队列的数据（基线[2012-2015 年]和 3 年随访[2015-2018 年]）。如果参与者自我报告患有糖尿病，或糖化血红蛋白 A 水平为 7%或更高，我们将其定义为患有糖尿病；如果参与者的流行病学研究中心抑郁评分在 10 或更高，或正在接受抑郁治疗，我们将其定义为患有抑郁。我们排除了基线时患有抑郁（队列 1）和基线时患有糖尿病（队列 2）的参与者，以分别评估糖尿病和抑郁发病率之间以及抑郁和糖尿病发病率之间的关联。我们构建了逻辑回归模型，并按移民身份进行了交互作用的检验。
队列 1（n=20723；平均年龄 62.7 岁，标准差[SD]10.1 岁；47.6%为女性）包括 3766（18.2%）名移民。在移民中，16.4%患有糖尿病，而非移民中这一比例为 15.6%。糖尿病与非移民中抑郁风险增加相关（调整后的优势比[OR]1.27，95%置信区间[CI]1.08-1.49），但在移民中无此相关性（调整后的 OR 1.12，95% CI 0.80-1.56）。年龄较小、女性、体重变化、睡眠质量差和疼痛增加了抑郁风险。队列 2（n=22054；平均年龄 62.1 岁，SD 10.1 岁；52.2%为女性）包括 3913（17.7%）名移民。抑郁与非移民（调整后的 OR 1.39，95% CI 1.16-1.68）和移民（调整后的 OR 1.60，95% CI 1.08-2.37）中糖尿病风险增加相关。年龄较小、男性、腰围、体重变化、高血压和心脏病增加了糖尿病风险。
我们发现糖尿病和抑郁之间存在总体的双向关联，而移民身份并没有显著改变这种关联。对于患有抑郁的人，应该考虑筛查糖尿病；对于患有糖尿病的人，应该考虑筛查抑郁。
