| In the past few decades,the rapid development of economic,dramatic change of lifestyles,and acceleration of population aging have led to a surge in the number of people suffering from chronic non-communicable disease such as cardiovascular disease,diabetes and caner,leading to a huge social and economic burden.Various risk factors have been reported to be associated with the development and progression of those common chronic diseases.Among them,depression has received considerable attention recently.Depression has been a leading cause of disability adjusted life year(DALY)according to the Global Burden of Disease Study.Many studies have been conducted regarding the association between depression and multiple chronic diseases in western countries.However,the evidence is not conclusive due to the low quality,small sample size,and poor controlling of the confounding factors of some previous studies.Besides,there are limited high-quality studies in Chinese populations.Therefore,we aimed to explore the relations of depression with incidence of type 2 diabetes,all-cause mortality and cardiovascular disease mortality based on large,high-quality prospective Chinese cohorts and to provide evidence foundation for prevention and treatment of depression and these chronic diseases in China.Part 1: Association between depression and risk of type 2 diabetes: a large prospective cohort study in Chinese adultsObjective: Depression is a leading cause of disease burden worldwide,and associated with higher risk of incidence of type 2 diabetes(T2D)in western populations.We aimed to prospectively evaluate the association between depression and risk of T2 D in a Chinese population.Methods: We used data from the China Kadoorie Biobank study(2004-2013),in which 461213 participants free of diabetes,coronary heart disease,stroke,and cancer were followed from baseline(2004-2008)to December 31,2013.A modified Chinese version of Composite International Diagnostic Interview Short-Form(CIDI-SF)was used to assess past year depression.Participants who responded positive to depression screening questions but did not meet the diagnosis criteria were considered as having depressive symptoms only.Incident diabetes cases were identified through linkage with established regional disease registries and national health insurance databases.Cox proportional hazards regression model was used to calculate hazard ratio(HR)and 95% confidence interval(95% CI)for the association after adjusting for diabetes risk factors.Results: We documented 8784 incident type 2 diabetes cases during a follow-up of 3291908 person-years.We observed a higher incidence rate of type 2 diabetes in participants with depression(3.36 per 1000 person-years)than those without(2.66 per 1000 person-years),and the multivariable-adjusted HR was 1.31(95% CI 1.04-1.66).Compared with participants without depressive symptoms,the HR(95% CI)was 1.19(1.05-1.35)for participants with depressive symptoms only and 1.32(1.05-1.68)for those with depression.There was no significant change in the association between depression and type 2 diabetes after stratified analysis by age,gender,and BMI.In the sensitivity analyses,the association between depression and risk of type 2 diabetes was not materially changed after excluding incident diabetes cases diagnosed within the first two years of follow-up(HR 1.31,95% CI 1.02–1.70),or excluding participants with baseline psychiatric disorders(HR 1.32,95% CI 1.04–1.68),or additional exclusion of those with neurasthenia disorders(HR 1.27,95% CI 0.99–1.64).In addition,significant association was also found when including those with baseline history of cancer,coronary heart disease and stroke in the analysis(HR 1.34,95% CI 1.07–1.67).Conclusions: In our large prospective cohort study of Chinese adults,depression was significantly and independently associated with an increased risk of type 2 diabetes,and there might be a dose-response relation between depression severity and diabetes risk.Part 2: Association between depression and all-cause and cardiovascular mortality: two prospective cohorts in Chinese adultsObjective: Depression is a leading cause of disease burden worldwide,and associated with higher risk of mortality in western populations.To investigate whether depression is a risk factor for all-cause and cardiovascular mortality in Chinese adultsMethods: We prospectively followed 512712 adults aged 30-79 years in the China Kadoorie Biobank(CKB)study from 2004 to 2016,and 26298 adults aged 32 to 104 years in the Dongfeng-Tongji(DFTJ)study from 2008 to 2016.Depression was evaluated by the modified Chinese version of Composite International Diagnostic Interview ShortForm(CIDI-SF)in the CKB study and a 7-item symptoms questionnaire(modified from CIDI-SF)in the DFTJ study.Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios(HRs)and corresponding 95% confidence intervals(CIs)for the association between depression and mortality.Results from the two cohorts were combined using an inverse variance–weighted meta-analysis by the randomeffects model.Results: We documented 44065 and 2571 total deaths(including 18273 and 1013 cardiovascular deaths)in the CKB and DFTJ studies,respectively.In the multivariate model,depression was associated with an increased risk of all-cause and cardiovascular mortality in both cohorts,and the pooled HR(95% CI)was 1.24(1.10-1.40)for all-cause mortality and 1.27(1.14-1.42)for cardiovascular mortality.The associations were significant only in men [pooled HR(95% CI)1.37(1.13-1.66)for all-cause mortality and 1.45(1.25-1.68)for cardiovascular mortality],but not in women [1.12(0.99-1.27)and 1.11(0.94-1.30),respectively].The association between depression and mortality remained unchanged in the sensitivity analysis of excluding individuals who died during the first two years of follow-up(CKB cohort: n=5261;DFTJ cohort: n=1204),or excluding participants with baseline history of cancer,CHD,or stroke(CKB cohort: n=25,514;DFTJ cohort: n=6633),or excluding individuals aged 80 or older in DFTJ cohort(n=533),or using five or more symptoms as the cut-off point to define depression.Conclusions: Depression was associated with an increased risk of all-cause and cardiovascular mortality in Chinese adults,particularly in men.Our findings highlight the importance and urgency of depression management as a measure of preventing premature deaths in China. |
PDF Full Text Request