University of Edinburgh, College of Medicine and Veterinary Medicine, Centre for Population Health Sciences, Usher Institute, United Kingdom.
J Psychosom Res. 2022 Sep;160:110978. doi: 10.1016/j.jpsychores.2022.110978. Epub 2022 Jun 22.
We aimed to investigate the individual and combined associations of depression and low socioeconomic status (SES) with risk of major cardiovascular events (MCVE), defined as first-ever fatal or non-fatal stroke or myocardial infarction, in a large prospective cohort study.
We used data from 466,238 UK Biobank participants, aged 40-69 years without cardiovascular disease, bipolar disorder or schizophrenia at baseline. We performed Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the individual and combined associations of depression and each of educational attainment, area-based deprivation and income with risk of MCVE. We assessed effect modification and explored interaction on the additive and multiplicative scale.
Depression, low education, high area-based deprivation and low income were individually associated with increased risks of MCVE (adjusted HR, 95% CI: 1.28, 1.19-1.38; 1.20, 1.14-1.27; 1.17, 1.11-1.23; and 1.22, 1.16-1.29, respectively). Depression was associated with increased risks of MCVE among individuals with high and low SES. Individuals with depression and each of low education, high area-based deprivation and low income were at particularly high risk of MCVE (HR, 95% CI: 1.50, 1.38-1.63; 1.63, 1.46-1.82; 1.31, 1.23-1.40, respectively). There was interaction between depression and area-based deprivation on multiplicative and additive scales but no interaction with education or income.
Depression was associated with increased risks of MCVE among individuals with high and low SES, with particularly high risks among those living in areas of high deprivation.
我们旨在通过一项大型前瞻性队列研究，调查抑郁和低社会经济地位（SES）对主要心血管事件（MCVE）风险的个体和联合关联，MCVE 定义为首次致命或非致命性中风或心肌梗死。
我们使用来自 UK Biobank 的 466,238 名年龄在 40-69 岁之间、基线时无心血管疾病、双相情感障碍或精神分裂症的参与者的数据。我们使用 Cox 比例风险模型来估计抑郁以及教育程度、基于区域的贫困程度和收入与 MCVE 风险的个体和联合关联的调整后的危险比（HR）和 95%置信区间（CI）。我们评估了效应修饰并在加性和乘法尺度上探索了相互作用。
抑郁、低教育程度、高区域贫困和低收入与 MCVE 风险增加相关（调整后的 HR，95%CI：1.28，1.19-1.38；1.20，1.14-1.27；1.17，1.11-1.23；和 1.22，1.16-1.29，分别）。抑郁与 SES 较高和较低的个体 MCVE 风险增加有关。抑郁和低教育程度、高区域贫困和低收入的个体患 MCVE 的风险特别高（HR，95%CI：1.50，1.38-1.63；1.63，1.46-1.82；1.31，1.23-1.40，分别）。抑郁和基于区域的贫困之间存在乘法和加法尺度上的相互作用，但与教育或收入没有相互作用。
抑郁与 SES 较高和较低的个体 MCVE 风险增加有关，生活在贫困程度较高地区的个体风险特别高。
