抑郁症状的存在与髋部骨折(HFs)的风险增加有关。然而,很少有研究调查中国老年人抑郁症状与事件HFs之间的纵向关系,和潜在的机制仍然不清楚。
为了调查抑郁症状和事件HFs之间的关系,认知功能和日常生活活动障碍(ADL)在中国老年人群中的中介作用。
这项基于人群的队列研究包括6336名中国老年人(年龄范围,60-101年)在基线时没有HFs的病史,并且在随访期间有完整的数据。离散时间Cox回归用于评估抑郁症状与事件HFs之间的关系。我们进行了自举的多重中介分析,以检查认知功能和ADL损害对该关联的影响.
在6336名参与者中(3172名女性[50.1%];平均[SD]年龄,67.9[6.6]年),264名(4.2%)受试者有HFs发作。在调整了年龄之后,性别,教育,婚姻状况,现居,吸烟状况,饮酒状况,身体质量指数,慢性疾病的数量,和瀑布历史,抑郁症状升高与HFs风险增加独立相关(调整后风险比[aHR]:1.42;95%CI:1.07~1.88).然而,在校正认知功能和ADL损害后,这种关联不再显著(aHR:1.09;95%CI:0.78~1.53).当死亡率和事件HFS被建模为复合结果时,在校正认知功能和ADL损害后,抑郁症状与综合结局之间的关联也无显著性.此外,调解模型表明,认知下降(间接效应:β=0.002,95%CI:0.001至0.003)和ADL损害(间接效应:β=0.002,95%CI:0.000至0.003)完全介导了抑郁症状之间的关联。调整年龄后,性别,瀑布历史,和慢性疾病的数量。
在中国老年人中证实了抑郁症状与事件HFs之间的正相关,这完全由认知功能下降和ADL损害介导。这项研究为抑郁症状在突发事件中的潜在作用提供了新的思路。
The presence of depressive symptoms is associated with increasing risks of hip fractures (HFs). However, few studies investigated the longitudinal relationship between depressive symptoms and incident HFs among Chinese older adults, and the underlying mechanisms remain unclear.
To investigate the association between depressive symptoms and incident HFs, and the mediating role of cognitive function and impairment in activities of daily living (ADL) in the association among the older adults in China.
This population-based cohort study included 6336 Chinese older adults (age range, 60-101 years) without the history of HFs at baseline and with complete data during the follow-up. Discrete-time Cox regression was used to evaluate the relationship between depressive symptoms and incident HFs, and bootstrapped multiple mediation analyses were conducted to examine the effects of cognitive function and ADL impairment on the association.
Among 6336 participants (3172 women [50.1%]; mean [SD] age, 67.9 [6.6] years), 264 (4.2%) subjects had HFs onset. After adjusting for age, sex, education, marital status, current residence, smoking status, drinking status, body mass index, number of chronic conditions, and falls history, elevated depressive symptoms were independently associated with increasing risks of HFs (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.07 to 1.88). However, this association was no longer significant (aHR: 1.09; 95% CI: 0.78 to 1.53) after adjusting for cognitive function and ADL impairment. When mortality and incident HFs were modeled as a composite outcome, the association between depressive symptoms and combined outcomes also remained non-significant after adjusting for cognitive function and ADL impairment. Furthermore, the mediation model demonstrated that cognitive decline (indirect effect: β = 0.002, 95% CI: 0.001 to 0.003) and ADL impairment (indirect effect: β = 0.002, 95% CI: 0.000 to 0.003) fully mediated the association between depressive symptoms and incident HFs after adjusting for age, sex, falls history, and number of chronic conditions.
The positive association between depressive symptoms and incident HFs was confirmed among Chinese older adults, which was fully mediated by cognitive decline and ADL impairment. This study shed new light on the potential role played by depressive symptoms in incident HFs.