| 唐秀容,邓鑫敏,张德来.中老年人心理躯体共病演变与心血管疾病风险：一项全国性纵向队列研究[J].安徽医药,待发表. |
| 中老年人心理躯体共病演变与心血管疾病风险：一项全国性纵向队列研究 |
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| 投稿时间：2026-08-21 录用日期：2026-10-29 |
| DOI： |
| 中文关键词: 抑郁症状 多病共存 心血管疾病 中老年人 心理躯体共病 |
| 英文关键词: |
| 基金项目:四川省中医药管理局科学技术研究专项,(编号：2023MS455) |
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| 中文摘要: |
| 目的：观察中国中老年人抑郁症状与躯体多病共存状态的变化，并分析不同心理躯体健康状态与新发心血管疾病的关系。方法：选取中国健康与养老追踪调查2011、2013、2015、2018和2020年数据。纳入2011年年龄≥45岁、无心脏病或卒中，且主要研究变量资料完整的10 101名参与者。采用10项流调中心抑郁量表评价抑郁症状，9类非心血管慢性病中同时患有≥2种定义为躯体多病。根据每轮调查时抑郁症状和躯体多病情况，将参与者分为均无、仅心理问题、仅躯体多病和心理躯体共病4种状态，并以该轮状态预测下一轮新发心脏病或卒中。采用离散时间互补对数-对数模型计算风险比及95%置信区间。结果：共形成30 657个人期，发生复合心血管事件2 112例，其中心脏病1 584例、卒中605例。2011—2018年，心理躯体共病比例由13.0%升至22.1%，仅躯体多病比例由14.0%升至25.9%，均无状态比例由51.3%降至37.0%。完全调整后，与均无组相比，仅心理问题、仅躯体多病和心理躯体共病组的新发复合心血管疾病风险均升高，HR及95%CI分别为1.38（1.20～1.58）、1.97（1.76～2.21）和2.51（2.23～2.82），均P<0.001。心理躯体共病与新发心脏病和卒中的HR分别为2.45（2.14～2.81）和2.74（2.22～3.39）。心理问题与躯体多病的乘法交互作用无统计学意义；经样条调整、死亡竞争事件分析及多重插补后，主要关联方向未变。结论：中国中老年人心理躯体共病比例随随访时间增加。抑郁症状、躯体多病及二者共存均与后续心血管疾病风险升高有关，其中心理躯体共病者关联强度较大。 |
| 英文摘要: |
| Objective: To describe changes in the co-occurrence of depressive symptoms and somatic multimorbidity among middle-aged and older Chinese adults and to examine its association with incident cardiovascular disease. Methods: Data were drawn from the 2011, 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study. The analysis included 10,101 adults aged 45 years or older who had no heart disease or stroke in 2011 and had complete data on the main study variables. Depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression Scale. Somatic multimorbidity was defined as the presence of at least two of nine non-cardiovascular chronic conditions. At each wave, participants were classified as having neither condition, depressive symptoms only, somatic multimorbidity only, or both conditions. Each wave-specific health state was related to incident heart disease or stroke at the following wave using discrete-time complementary log-log models. Results: The analysis included 30,657 person-periods and 2,112 composite cardiovascular events, including 1,584 cases of heart disease and 605 cases of stroke. Between 2011 and 2018, the prevalence of co-occurring depressive symptoms and somatic multimorbidity increased from 13.0% to 22.1%, while the prevalence of somatic multimorbidity alone increased from 14.0% to 25.9%. The proportion with neither condition decreased from 51.3% to 37.0%. After full adjustment, the hazard ratios for incident composite cardiovascular disease were 1.38 (95% CI: 1.20–1.58) for depressive symptoms only, 1.97 (95% CI: 1.76–2.21) for somatic multimorbidity only, and 2.51 (95% CI: 2.23–2.82) for both conditions, compared with neither condition (all P<0.001). For participants with both conditions, the hazard ratios were 2.45 (95% CI: 2.14–2.81) for heart disease and 2.74 (95% CI: 2.22–3.39) for stroke. No statistically significant multiplicative interaction was observed. The association remained positive in analyses using spline adjustment, accounting for death as a competing event category, and multiple imputation. Conclusion: The co-occurrence of depressive symptoms and somatic multimorbidity became more common over time and was associated with the highest risk of subsequent cardiovascular disease. |
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