Importance:Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective:To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants:This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures:Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures:Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results:Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance:In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.

译文

重要性:抑郁症与高收入国家的心血管疾病(CVD)和癌症的发生和过早死亡有关,但尚不清楚在低收入和中等收入国家以及大多数人所在的城市地区是否如此抑郁症现在生活。
目的:确定经济发展水平不同的国家和城乡地区的抑郁症状与心血管疾病和全因死亡率之间的关系。
设计,背景和参与者:这项基于人群的多中心队列研究于2005年1月至2019年6月进行(中位随访时间为9.3年),纳入了来自五大洲21个经济不同国家的370个城市社区和314个农村社区。年龄在35至70岁之间的符合条件的参与者入选。分析于2018年2月开始,至2019年9月结束。
暴露:来自简短综合国际诊断面试的四个或更多个自我报告的抑郁症状。
主要结果和措施:事件性CVD,全因死亡率,以及对事件性CVD或全因死亡率的综合测量。
结果:145862名参与者中,有61235名(58%)为男性,平均(SD)年龄为50.05(9.7)岁。在这些患者中,有15983名(11%)在基线时报告了4种或更多种抑郁症状。抑郁与突发性CVD(危险比[HR]为1.14; 95%CI为1.05-1.24),全因死亡率(HR为1.17; 95%CI为1.11-1.25),CVD /死亡率综合结果(HR)相关。在多变量模型中,分别为1.18; 95%CI,1.11-1.24),心肌梗塞(HR,1.23; 95%CI,1.10-1.37)和非心血管死亡(HR,1.21; 95%CI,1.13-1.31)。合并症状的风险随症状数量的增加而逐渐增加,在有7种症状的人群中最高(HR,1.24; 95%CI,1.12-1.37),最低的有1种症状(HR,1.05; 95%CI,0.92 -1.19) ; P表示趋势<.001)。在7个不同的地理区域和所有经济水平的国家中,具有4种或更多种抑郁症状与综合结果之间的关联相似,但与农村地区(HR)相比,城市地区(HR,1.23; 95%CI,1.13-1.34)更强,1.10; 95%CI,1.02-1.19)社区(互动率P = 0.001)和男性(HR,1.27; 95%CI,1.13-1.38),而女性(HR,1.14; 95%CI,1.06- 1.23;交互作用的P <<。001)。
结论与相关性:在这项大型的,基于人群的队列研究中,患有抑郁症状的成年人在经济上多样化的环境中,特别是在城市地区,患心血管疾病的风险增加和死亡率增加。作为减少全球非传染性疾病负担的全面战略的一部分,应优先提高对这些身体健康风险的了解和认识。

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