老年人估计的心肺适能与抑郁症状之间关联的跨国差异：三项全国性队列研究的结果

Cross-national differences in the association between estimated cardiorespiratory fitness and depressive symptoms among older adults: findings from three nationwide cohort studies.

作者信息

He Xue, Li Cong, Hua GuangYao, Wang Yan, Zhang Lijun, Cheng Chingyu, Jiao Jinghua, Yu Honghua, Yang Xiaohong, Liu Lei

机构信息

Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.

Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.

出版信息

BMC Med. 2025 Jul 1;23(1):363. doi: 10.1186/s12916-025-04175-y.

DOI:10.1186/s12916-025-04175-y

PMID:40598464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220467/

Abstract

BACKGROUND

Cardiorespiratory fitness (CRF) is a modifiable risk factor for chronic diseases, but its association with depressive symptoms remains unclear, particularly across different populations. We aimed to investigate the link between estimated CRF (eCRF) and incident depressive symptoms among individuals over 50 years old, and to explore potential cross-country variations in this association.

METHODS

Data were retrieved from three national cohorts: the Health and Retirement Study (HRS, United States), the English Longitudinal Study of Ageing (ELSA, England), and the China Health and Retirement Longitudinal Study (CHARLS, China). eCRF was estimated using sex-specific algorithms and categorized into low (quintiles 1), moderate (quintiles 2-3), and high (quintiles 4-5) levels. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression Scale (CESD-8) (cutoff ≥ 3) in HRS and ELSA, and the 10-item version (CESD-10) (cutoff ≥ 10) in CHARLS. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.

RESULTS

This study included 13,680 participants (4195 from HRS, 5421 from ELSA, and 4064 from CHARLS) with median follow-ups of 9.78, 12.11, and 5.73 years, respectively. Depressive symptoms incidence was 22.79% in HRS, 22.15% in ELSA, and 40.58% in CHARLS. Per 1-SD increase in eCRF was associated with 9% lower risk of depressive symptoms in HRS (HR = 0.91; 95% CI, 0.87-0.96), 8% lower in ELSA (HR = 0.92; 95% CI, 0.87-0.97), but 6% higher in CHARLS (HR = 1.06; 95% CI, 1.01-1.16). Compared with the low eCRF level group, high eCRF level was associated with decreased risk of depressive symptoms in HRS (HR = 0.69; 95% CI, 0.55-0.85) and ELSA (HR = 0.62; 95% CI, 0.48-0.79), but increased risk in CHARLS (HR = 1.27; 95% CI, 1.01-1.61). Subgroup analyses revealed that the associations were modified by smoking status (HRS), by gender and presence of diabetes (ELSA), and by the presence of hypertension (CHARLS) (P for interaction < 0.05).

CONCLUSIONS

A higher level of eCRF was associated with reduced depressive symptoms risk in the US (HRS) and England (ELSA) older adults but with increased risk in China (CHARLS), emphasizing the need for nation-specific public health strategies.

摘要

背景

心肺适能（CRF）是慢性病的一个可改变的风险因素，但其与抑郁症状的关联仍不明确，尤其是在不同人群中。我们旨在调查50岁以上人群中估计的心肺适能（eCRF）与新发抑郁症状之间的联系，并探讨这种关联在不同国家之间的潜在差异。

方法

数据取自三个全国性队列：健康与退休研究（HRS，美国）、英国老龄化纵向研究（ELSA，英国）和中国健康与退休纵向研究（CHARLS，中国）。使用特定性别的算法估计eCRF，并将其分为低（五分位数1）、中（五分位数2 - 3）和高（五分位数4 - 5）水平。在HRS和ELSA中，使用8项流行病学研究中心抑郁量表（CESD - 8）（临界值≥3）测量抑郁症状，在CHARLS中使用10项版本（CESD - 10）（临界值≥10）。Cox比例风险模型估计风险比（HRs）和95%置信区间（CIs），并对潜在混杂因素进行调整。

结果

本研究纳入了13680名参与者（HRS中有4195名，ELSA中有5421名，CHARLS中有4064名），中位随访时间分别为9.78年、12.11年和5.73年。HRS中抑郁症状发生率为22.79%，ELSA中为22.15%，CHARLS中为40.58%。eCRF每增加1个标准差，HRS中抑郁症状风险降低9%（HR = 0.91；95% CI，0.87 - 0.96），ELSA中降低8%（HR = 0.92；95% CI，0.87 - 0.97），但CHARLS中升高6%（HR = 1.06；95% CI，1.01 - 1.16）。与低eCRF水平组相比，高eCRF水平与HRS（HR = 0.69；95% CI，0.55 - 0.85）和ELSA（HR = 0.62；95% CI，0.48 - 0.79）中抑郁症状风险降低相关，但与CHARLS中风险升高相关（HR = 1.27；95% CI，1.01 - 1.61）。亚组分析显示，这种关联受到吸烟状况（HRS）、性别和糖尿病状况（ELSA）以及高血压状况（CHARLS）的影响（交互作用P < 0.05）。