Youanmen Community Healthcare Center of Fengtai District, Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Psychiatry. 2024 Oct 30;24(1):752. doi: 10.1186/s12888-024-06159-3.
Unfavorable social determinants of health (SDoH) are associated with depression. Both depression and SDoH are associated with increased risks of mortality, but their joint impacts on mortality risks remain unclear. This study aims to investigate the joint effects of depression and SDoH on mortality risk.
Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, 24,727 adults aged ≥ 20 were included. SDoH was assessed based on the 5 domains outlined in the U.S. Healthy People 2030 initiative. The cumulative number of unfavorable SDoH was calculated and categorized into low and high burden levels. The definition of depression was based on the Patient Health Questionnaire-9 (PHQ-9) scores ≥ 10. The joint associations of depression and SDoH with all-cause, cardiovascular disease (CVD), and cancer mortality were examined using Cox proportional hazard models.
We identified 2,377 (6.84%) all-cause deaths (CVD, 717; cancer, 606) during a median follow-up of 7.0 years. Depression was associated with increased mortality risks, and SDoH could explain 32.4% and 28.3% of the associations between depression and all-cause and CVD mortality, respectively. No significant interactions were observed between depression and SDoH on mortality. However, a low burden of unfavorable SDoH reduced the risk of all-cause mortality in depressed patients (hazard ratio [HR], 0.58; 95% confidence interval [CI]: 0.36-0.92). In the joint analysis, individuals with both depression and a high burden of unfavorable SDoH had the highest risks of all-cause and CVD mortality. Specifically, compared with individuals with no depression and a low burden of unfavorable SDoH, those with depression and a high burden of unfavorable SDoH had higher risks of all-cause (HR, 2.52; 95% CI: 2.01-3.18) and CVD mortality (HR, 2.79; 95% CI: 1.95-3.99).
Adults with both depression and a high burden of unfavorable SDoH had the highest risks of all-cause mortality and CVD mortality. The result suggests considering depression and SDoH jointly in developing targeted intervention strategies to improve survival outcomes and calls for larger cohort studies and clinical trials to validate our findings.
不良的社会决定因素（SDoH）与抑郁症有关。抑郁症和 SDoH 都与更高的死亡率风险相关，但它们对死亡率风险的共同影响尚不清楚。本研究旨在调查抑郁症和 SDoH 对死亡率风险的联合影响。
利用 2007-2018 年国家健康和营养检查调查（NHANES）的数据，纳入了 24727 名年龄≥20 岁的成年人。SDoH 是根据美国《健康人民 2030 倡议》中概述的 5 个领域来评估的。计算了不利 SDoH 的累积数量，并分为低和高负担水平。抑郁症的定义是基于患者健康问卷-9（PHQ-9）评分≥10。使用 Cox 比例风险模型检查了抑郁症和 SDoH 与全因、心血管疾病（CVD）和癌症死亡率的联合关联。
在中位随访 7.0 年期间，我们发现了 2377 例（6.84%）全因死亡（CVD，717 例；癌症，606 例）。抑郁症与死亡率风险增加有关，SDoH 可以分别解释抑郁症与全因和 CVD 死亡率之间关系的 32.4%和 28.3%。在死亡率方面，未观察到抑郁症和 SDoH 之间存在显著的交互作用。然而，在患有抑郁症的患者中，低负担的不利 SDoH 降低了全因死亡率的风险（风险比[HR]，0.58；95%置信区间[CI]：0.36-0.92）。在联合分析中，同时患有抑郁症和高负担不利 SDoH 的个体具有最高的全因和 CVD 死亡率风险。具体而言，与无抑郁症且不利 SDoH 负担低的个体相比，患有抑郁症且不利 SDoH 负担高的个体的全因（HR，2.52；95%CI：2.01-3.18）和 CVD 死亡率（HR，2.79；95%CI：1.95-3.99）风险更高。
同时患有抑郁症和高负担不利 SDoH 的成年人具有最高的全因死亡率和 CVD 死亡率风险。结果表明，在制定以提高生存结果为目标的干预策略时，应同时考虑抑郁症和 SDoH，并呼吁开展更大规模的队列研究和临床试验来验证我们的发现。
