Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China.
BMC Geriatr. 2022 Aug 12;22(1):660. doi: 10.1186/s12877-022-03329-4.
With the population aging, multiple chronic diseases, depressive symptoms, and stroke are increasingly common among middle-aged and elderly adults worldwide. This study aimed to explore the independent associations of multiple chronic diseases and depressive symptoms as well as their combination with incident stroke in a prospective cohort of Chinese middle-aged and elderly adults, and to sensitively estimate the association between each type of chronic disease and incident stroke.
This study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8389 participants meeting the inclusion criteria at baseline (between 2011 and 2012) survey were included, and 7108 eligible participants completed the follow-up survey over 8 years (Wave 4, in 2018). Questionnaire information, physical examination, and clinical and biochemical measurements were collected.
The mean (SD) age at baseline was 58.5 (± 9.1) years. Multiple chronic disease and depressive symptoms were independently associated with incident stroke. After adjusting for control variables, patients having 1 type of chronic disease and depressive symptoms were at 1.943 (95% CI = 1.166-3.238) times higher risk of incident stroke than those without chronic disease and depressive symptoms, and patients having at least 2 types of chronic diseases and depressive symptoms were at 3.000 (95% CI = 1.846-4.877) times higher risk of incident stroke; the magnitudes of the associations increased by the numbers of having chronic diseases and depressive symptoms. Sensitivity analyses incorporating all five types of chronic disease (i.e., hypertension, dyslipidemia, heart disease, diabetes, and chronic kidney disease) showed that the magnitude of the associations between hypertension and incident stroke was most significant.
We identified significant independent and combined longitudinal associations of multiple chronic diseases and depressive symptoms with incident stroke, and the combined associations reflected a dose-response relationship. The association between hypertension and incident stroke was strongest among the five chronic diseases.
随着人口老龄化，全球中老年人群中多种慢性疾病、抑郁症状和中风的发病率越来越高。本研究旨在探讨中国中老年人群中多种慢性疾病和抑郁症状与中风发病的独立关联，以及它们的组合与中风发病的关系，并灵敏估计每种慢性疾病与中风发病的关联。
本研究使用了中国健康与养老追踪调查（CHARLS）的数据。共纳入 8389 名符合基线（2011 年至 2012 年）调查纳入标准的参与者，其中 7108 名符合条件的参与者在 8 年后（2018 年）完成了随访调查。通过问卷调查、体格检查和临床及生化指标测量收集数据。
基线时的平均（SD）年龄为 58.5（±9.1）岁。多种慢性疾病和抑郁症状与中风发病独立相关。调整了控制变量后，患有 1 种慢性疾病和抑郁症状的患者发生中风的风险是无慢性疾病和抑郁症状的患者的 1.943 倍（95%CI=1.166-3.238），至少患有 2 种慢性疾病和抑郁症状的患者发生中风的风险是无慢性疾病和抑郁症状的患者的 3.000 倍（95%CI=1.846-4.877）；患病数量越多，关联程度越大。纳入所有五种慢性疾病（即高血压、血脂异常、心脏病、糖尿病和慢性肾脏病）的敏感性分析显示，高血压与中风发病之间的关联幅度最大。
我们发现多种慢性疾病和抑郁症状与中风发病存在显著的独立和联合纵向关联，且联合关联呈剂量-反应关系。在五种慢性疾病中，高血压与中风发病的关联最强。
