Department of Health Management, Faculty of Military Health Service, Naval Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China, 86 021 81871450.
Department of Emergency, Naval Medical Center, Naval Medical University, Shanghai, China.
JMIR Public Health Surveill. 2024 Aug 1;10:e52536. doi: 10.2196/52536.
Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas.
This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China.
We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension.
The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%).
Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.
高血压是中国老年人口中最常见的慢性病，占总人口的比例越来越大。与健康人群相比，患有慢性病的老年人更容易出现抑郁症状，这在中国老年人群中得到了证实，其中高血压患者的抑郁症状发生率因居住在城市或农村地区而异。
本研究旨在探讨中国城乡高血压老年患者抑郁症状差异的影响因素和原因。
我们采用横断面研究设计，从 2018 年第八次中国长寿健康纵向调查中提取数据。采用 Fairlie 模型分析导致城乡高血压老年人群抑郁症状差异的因素。
本研究样本量为 5210 人，12.8%（n=669）的参与者出现抑郁症状。农村和城市地区的抑郁症状比例分别为 14.1%（n=468）和 10.7%（n=201）。在农村地区，受教育年限（1-6 年：OR 0.68，95%CI 1.10-1.21；≥7 年：OR 0.47，95%CI 0.24-0.94）、饮酒（是：OR 0.52，95%CI 0.29-0.93）、运动（是：OR 0.78，95%CI 0.56-1.08）和睡眠时间（6.0-7.9 小时：OR 0.29，95%CI 0.17-0.52；8.0-9.9 小时：OR 0.24，95%CI 0.13-0.43；≥10.0 小时：OR 0.22，95%CI 0.11-0.41）是高血压老年患者抑郁症状的保护因素，而性别（女性：OR 1.94，95%CI 1.33-2.81）、自我报告收入状况（贫困：OR 3.07，95%CI 2.16-4.37）和日常生活活动（ADL）功能障碍（轻度：OR 1.69，95%CI 1.11-2.58；重度：OR 3.03，95%CI 1.46-6.32）是高血压老年患者抑郁症状的风险因素。在城市地区，年龄（90-99 岁：OR 0.37，95%CI 0.16-0.81；≥100 岁：OR 0.19，95%CI 0.06-0.66）、运动（是：OR 0.33，95%CI 0.22-0.51）和睡眠时间（6.0-7.9 小时：OR 0.27，95%CI 0.10-0.71；8.0-9.9 小时：OR 0.16，95%CI 0.06-0.44；≥10.0 小时：OR 0.18，95%CI 0.06-0.57）是高血压老年患者抑郁症状的保护因素，而受教育年限（1-6 年：OR 1.91，95%CI 1.05-3.49）、自我报告收入状况（贫困：OR 2.94，95%CI 1.43-6.08）和 ADL 功能障碍（轻度：OR 2.38，95%CI 1.39-4.06；重度：OR 3.26，95%CI 1.21-8.76）是高血压老年患者抑郁症状的风险因素。Fairlie 模型显示，91.61%的抑郁症状差异可以由协变量解释，包括受教育年限（贡献 63.1%）、自我报告收入状况（贡献 13.2%）、运动（贡献 45.7%）、睡眠时间（贡献 20.8%）、ADL 功能障碍（贡献-9.6%）和合并症（贡献-22.9%）。
与城市地区相比，农村地区的高血压老年患者抑郁症状更为严重，这可以用受教育年限、自我报告收入状况、运动、睡眠时间、ADL 功能障碍和合并症来解释。影响抑郁症状的因素在运动、睡眠时间、自我报告收入状况和 ADL 功能障碍方面存在相似之处，而在年龄、性别、受教育年限和饮酒方面存在差异。
