Ho Matthew Tsz Ho, Chan Joe Kwun Nam, Lo Heidi Ka Ying, Fang Catherine Zhiqian, Wong Corine Sau Man, Lee Krystal Chi Kei, Lai Francisco Tsz Tsun, Ng Amy Pui Pui, Chen Ken Qingqi, Wong William Chi Wai, Chang Wing Chung
Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong; Department of Psychiatry, United Christian Hospital, Hong Kong.
Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong.
Eur Neuropsychopharmacol. 2025 Mar;92:10-18. doi: 10.1016/j.euroneuro.2024.11.011. Epub 2024 Nov 30.
People with depression have increased premature mortality and elevated prevalence of diabetes-mellitus compared to general population. However, risk of mortality and diabetes-related complications among patients with depression and co-occurring diabetes is under-studied. This population-based propensity score-matched (1:10) cohort study identified 12,175 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 117,958 patients with incident-diabetes only (diabetes-only group) between 2002 and 2021 in Hong-Kong, using territory-wide medical-record database of public-healthcare services, to investigate whether depression increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Associations of depression with all-cause mortality, complication and post-complication all-cause mortality rates were examined by Cox proportional-hazards model. Complications were assessed by Diabetes-Complications-Severity-Index (DCSI). Associations of complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns) with all-cause mortality rate in depression were also examined. Our results showed that depression-diabetes group exhibited increased all-cause mortality risk (adjusted hazards-ratio: 1.06 [95 %CI: 1.02-1.10]) relative to diabetes-only group, particularly among men and older age group, with significantly higher rate of experiencing neuropathy (1.44 [1.27-1.62]) and metabolic complications (1.30 [1.09-1.56]) and lower likelihood of peripheral-vascular complications, retinopathy and nephropathy, albeit comparable macrovascular and microvascular complication rates. The mortality-rate-ratio for patients with depression and diabetes was significantly higher than patients with diabetes-only at a low level of complication burden. In conclusion, depression patients with co-occurring diabetes are at increased risk of excess mortality. Further research is warranted to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.
与普通人群相比，抑郁症患者的过早死亡率更高，糖尿病患病率也更高。然而，抑郁症合并糖尿病患者的死亡率和糖尿病相关并发症的风险研究不足。这项基于人群的倾向评分匹配（1:10）队列研究，利用香港全地区公共医疗服务的病历数据库，在2002年至2021年间，确定了12175例患有既往抑郁症和新发糖尿病的患者（抑郁症-糖尿病组）以及117958例仅患有新发糖尿病的患者（仅糖尿病组），以调查抑郁症是否会增加糖尿病患者的总体死亡率、并发症及并发症后死亡率。通过Cox比例风险模型检验抑郁症与全因死亡率、并发症及并发症后全因死亡率之间的关联。并发症通过糖尿病并发症严重程度指数（DCSI）进行评估。还研究了抑郁症患者中，并发症（以DCSI评分表示并发症负担）、特定类型以及并发症的双向组合（并发症模式）与全因死亡率之间的关联。我们的结果显示，与仅糖尿病组相比，抑郁症-糖尿病组的全因死亡风险增加（调整后的风险比：1.06 [95%置信区间：1.02 - 1.10]），尤其是在男性和老年人群中，神经病变（1.44 [1.27 - 1.62]）和代谢并发症（1.30 [1.09 - 1.56]）的发生率显著更高，而外周血管并发症、视网膜病变和肾病的发生率较低，尽管大血管和微血管并发症的发生率相当。在低并发症负担水平下，抑郁症合并糖尿病患者的死亡率与仅糖尿病患者相比显著更高。总之，抑郁症合并糖尿病患者的额外死亡风险增加。有必要进行进一步研究，以改善这一脆弱人群的糖尿病相关结局并缩小死亡率差距。
