中青年抑郁症状与脑卒中及全因死亡风险的关联研究

Association between depressive symptoms and risk of stroke and all-cause mortality in young and middle-aged adults

中文关键词:  抑郁症状  脑卒中  死亡风险  美国国家健康与营养调查  中青年人群  

英文关键词:Depressive symptoms  Stroke  Mortality risk  NHANES  Young and middle-aged adults

中文摘要:

      背景 当前关于抑郁症状与脑卒中及全因死亡风险的研究，多聚焦于老年群体或伴有慢性共病的传统高危人群。相比之下，中青年人群中抑郁症状对脑卒中及全因死亡风险的长期影响仍缺乏系统性评估，相关证据尚不充分。目的 探讨中青年人群中抑郁症状与脑卒中及全因死亡风险的关联性，拓展该年龄段的风险证据，为早期识别高危人群及制定干预策略提供流行病学依据。方法 基于美国国家健康和营养调查（NHANES）数据库2009年—2018年的数据，纳入14 947名18~64岁的中青年受访者作为研究对象。使用Logistic回归及限制性立方样条（RCS）模型分析抑郁症状与脑卒中的相关性。采用Cox比例风险模型、RCS模型及绘制K-M生存曲线,分析抑郁症状与全因死亡风险的关系。为验证主要结论的稳健性，按性别、高血压、糖尿病、高脂血症、体质量指数（BMI）及年龄分层进行了敏感性分析。结果 Logistic回归分析显示，与无明显抑郁组相比，轻度抑郁组脑卒中患病风险增加53.50%（OR=1.535，95% CI：1.147~2.053），中重度抑郁组增加132.90%（OR=2.329，95% CI：1.733~3.129）。RCS分析显示，PHQ-9评分与脑卒中患病风险呈近似线性剂量-反应关系（Pfor non-linearity=0.089），随着PHQ-9评分升高，脑卒中患病风险呈上升趋势。Cox回归分析显示，与无明显抑郁组相比，轻度抑郁组全因死亡风险增加48.80%（HR=1.488，95% CI：1.164~1.902），中重度抑郁组增加70.60%（HR=1.706，95% CI：1.310~2.221）。RCS分析显示，PHQ-9评分与全因死亡风险呈线性剂量-反应关系（Pfor non-linearity=0.440）；K-M曲线亦提示，随抑郁程度加重，全因死亡风险逐渐上升（P<0.05）。敏感性分析显示，抑郁症状与脑卒中及全因死亡风险的关系不受性别、高血压、糖尿病、高脂血症、BMI及年龄分层影响，结论稳健。结论 在中青年人群中，轻度抑郁和中重度抑郁均与脑卒中及全因死亡风险升高相关，且中重度抑郁组的风险更为突出；抑郁症状与上述风险存在正向剂量-反应关系。

英文摘要:

      Background Current research on the association between depression and the risk of stroke and all-cause mortality has primarily focused on elderly populations or traditional high-risk groups with chronic comorbidities. In contrast, the long-term impact of depressive symptoms on stroke and mortality among young and middle-aged adults has received limited attention, leaving a substantial gap in the evidence base. Objective To investigate the association between depressive symptoms and the risks of stroke and all-cause mortality among young and middle-aged adults, thereby expanding the risk evidence for this demographic and providing an epidemiological basis for early identification of high-risk individuals and the development of targeted intervention strategies. Methods Based on data from the National Health and Nutrition Examination Survey (NHANES） database (2009–2018）, we included 14,947 participants aged 18–64 years.Logistic regression and restricted cubic spline (RCS） models were employed to examine the association between depressive symptoms and stroke. Cox proportional hazards regression,RCS models,and Kaplan-Meier (K-M） survival curves were used to clarify the relationship between depressive symptoms and all-cause mortality risk.To verify the robustness of our main findings,sensitivity analyses were stratified by sex,hypertension,diabetes,hyperlipidemia, body mass index (BMI),and age. Results Logistic regression analysis revealed that,compared with the non-depressed group,the mild depression group exhibited a 53.50% increased risk of stroke (OR=1.535, 95% CI: 1.147~2.053), while the moderate-to-severe depression group showed the highest risk with a 132.90% increase (OR=2.329, 95% CI: 1.733~3.129). RCS analysis indicated a approximately linear dose-response relationship between PHQ-9 scores and stroke risk (Pfor non-linearity=0.089),with stroke risk increasing as PHQ-9 scores rose.Cox regression analysis demonstrated that,relative to the non-depressed group, the mild depression group had a 48.80% increased risk of all-cause mortality (HR=1.488, 95% CI: 1.164~1.902), and the moderate-to-severe depression group had a 70.60% increased risk (HR=1.706, 95% CI: 1.310~2.221).RCS analysis showed a linear dose-response relationship between PHQ-9 scores and all-cause mortality risk (Pfor non-linearity=0.440). K-M curves also indicated that all-cause mortality risk progressively increased with worsening depression severity (P<0.05). Sensitivity analyses confirmed that the associations between depression and risks of stroke and all-cause mortality were not modified by sex, hypertension, diabetes, hyperlipidemia, BMI, or age,indicating robust conclusions. Conclusion In young and middle-aged adults,both mild depression and moderate-to-severe depression were associated with increased risks of stroke and all-cause mortality, with the moderate-to-severe depression group showing more pronounced risk elevations. A positive dose-response relationship was observed between depressive symptoms and these risks.