Kiran Tanvi, Halder Pritam, Sharma Divya, Mehra Aseem, Goel Kapil, Behera Ashish
Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Department of Psychiatry Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
J Health Popul Nutr. 2025 Mar 3;44(1):61. doi: 10.1186/s41043-025-00753-1.
Research on the distribution and association of depression with tobacco consumption among young population is commonly prioritised in India, while studies on tobacco use among middle-aged (45-59 years) and elderly (≥ 60 years) adults are noticeably lacking. Thus, we conducted this study with the objectives of estimating the prevalence, distribution and determining the association of depression and tobacco consumption among middle-aged and elderly Indian population; overall and stratified into age group, gender, and geographical location.
Using dataset from Longitudinal Aging Study in India (LASI), a bivariate analysis was conducted among middle-aged (45-59 years) and elderly (≥ 60 years) Indians to estimate the prevalence of depression and tobacco consumption. States and Union Territories were categorised as low, medium, and high as per prevalence of depression and tobacco consumption, and spatial distribution maps were created. To reduce the confounding effects of demographic & socioeconomic and health-related & behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was employed to explore the association between depression (outcome variable) and tobacco consumption (explanatory variable) using STATA version 17. The p value < 0.05 was considered statistically significant.
Overall, 36.78% (36.03-37.55%) participants documented using any form of tobacco; with higher consumption of smokeless tobacco (SLT) (19.88%) than smoking (SM) (13.92%). The overall prevalence of depression was 7.62% irrespective of tobacco consumption, and 8.51% among participants consuming any form of tobacco. Mizoram had the highest consumption of tobacco in any form (78.21%), whereas Madhya Pradesh recorded the highest (14.62%) depression prevalence. Bihar, Uttar Pradesh, West Bengal, and Uttarakhand had both high prevalence of depression and any form of tobacco consumption. The average estimated treatment effect (ATE) indicated a positive association both between depression and any form of tobacco consumption (p value = 0.001) and with smokeless tobacco (p value = 0.001) consumption. Participants ever consuming any form of tobacco had 28% higher odds (aOR-1.28 (1.18-1.38). The odds of having depression were higher among females (aOR = 1.28 (1.17-1.41); richest (aOR-1.48 (1.32-1.65); living alone (aOR = 1.14 (1.01-1.33). Participants with comorbidity (aOR = 1.20 (1.10-1.30) and multimorbidity (aOR = 1.24 (1.13-1.36)) had higher odds of depression.
The study has established significant positive association between depression and tobacco consumption stratified into gender and age group. Prioritisation of mental health disorders like depression and tobacco prevention and cessation programmes must be implemented with focusing on females and the middle-aged population with community awareness and intersectoral collaborative effort irrespective of subnational-variations.
在印度，针对年轻人群中抑郁症的分布及其与烟草消费之间关联的研究通常受到优先重视，而针对中年（45 - 59岁）和老年（≥60岁）成年人烟草使用情况的研究明显不足。因此，我们开展了这项研究，目的是估计印度中年和老年人群中抑郁症的患病率、分布情况，并确定抑郁症与烟草消费之间的关联；总体情况以及按年龄组、性别和地理位置进行分层分析。
利用印度纵向老龄化研究（LASI）的数据集，对中年（45 - 59岁）和老年（≥60岁）印度人进行双变量分析，以估计抑郁症和烟草消费的患病率。根据抑郁症和烟草消费的患病率，将各邦和联邦属地分为低、中、高三类，并绘制空间分布图。为减少人口统计学、社会经济以及与健康相关和行为协变量的混杂效应，进行了倾向得分匹配（PSM）。使用STATA 17版进行嵌套多层回归建模，以探讨抑郁症（结果变量）与烟草消费（解释变量）之间的关联。p值<0.05被认为具有统计学意义。
总体而言，36.78%（36.03 - 37.55%）的参与者记录使用过任何形式的烟草；无烟烟草（SLT）的消费量（19.88%）高于吸烟（SM）（13.92%）。无论烟草消费情况如何，抑郁症的总体患病率为7.62%，在使用任何形式烟草的参与者中为8.51%。米佐拉姆邦任何形式烟草的消费量最高（78.21%），而中央邦抑郁症患病率最高（14.62%）。比哈尔邦、北方邦、西孟加拉邦和北阿坎德邦抑郁症患病率和任何形式烟草消费率都很高。平均估计治疗效果（ATE）表明，抑郁症与任何形式的烟草消费（p值 = 0.001）以及与无烟烟草消费（p值 = 0.001）之间均存在正相关。曾经使用过任何形式烟草的参与者患抑郁症的几率高28%（调整后比值比 - 1.28（1.18 - 1.38））。女性（调整后比值比 = 1.28（1.17 - 1.41））、最富有的人（调整后比值比 - 1.48（1.32 - 1.65））、独居者（调整后比值比 = 1.14（1.01 - 1.33））患抑郁症的几率更高。患有合并症（调整后比值比 = 1.20（1.10 - 1.30））和多重合并症（调整后比值比 = 1.24（1.13 - 1.36））的参与者患抑郁症的几率更高。
该研究确定了抑郁症与按性别和年龄组分层的烟草消费之间存在显著正相关。必须优先实施抑郁症等心理健康障碍以及烟草预防和戒烟计划，关注女性和中年人群，提高社区意识并开展跨部门协作，而不考虑次国家级别的差异。
