Association of depression severity and transition patterns of cardiometabolic multimorbidity.

OBJECTIVE We aimed to assess the association of depression severity with the incidence and progression of cardiometabolic multimorbidity (CMM) in middle-aged and older Chinese adults.

METHODS We analyzed data from 12,059 participants in the China Health and Retirement Longitudinal Study (CHARLS). Depression severity was categorized as none, mild-moderate, or severe using CES-D-10 scores. CMM was defined as the coexistence of two or more of type 2 diabetes, heart disease, or stroke. Cox proportional hazards models estimated the association of depression severity with first cardiometabolic disease (FCMD) and CMM. Multi-state models examined transitions from health to FCMD, CMM, and death.

RESULTS Over 7 years of follow-up, 2080 participants developed FCMD and 305 developed CMM. Compared to no depression, mild-moderate (HR: 1.22, 95%CI: 1.11-1.34) and severe depression (HR: 1.46, 95%CI: 1.24-1.73) were associated with increased risk of FCMD; only severe depression was associated with CMM (HR: 2.08, 95%CI: 1.42-3.04). Multi-state models showed both mild-moderate (HR: 1.19, 95%CI: 1.09-1.31) and severe depression (HR: 1.42, 95%CI: 1.20-1.67) increased the risk of transitioning from health to FCMD, and from health to death (HR: 1.35, 95%CI: 1.17-1.55 and HR: 1.76, 95%CI: 1.40-2.21, respectively). Severe depression also increased the risk of transition from FCMD to CMM (HR: 1.55, 95%CI: 1.05-2.27). Results were robust in subgroup and sensitivity analyses.

CONCLUSIONS Depression, particularly severe depression, was significantly associated with increased risks of incident cardiometabolic diseases, progression to multimorbidity, and mortality in middle-aged and older Chinese adults. Targeted interventions for depression may help delay CMM development.