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Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries Publisher Pubmed



Rajan S1, 2 ; Mckee M1 ; Rangarajan S2 ; Bangdiwala S2 ; Rosengren A3 ; Gupta R4 ; Kutty VR5 ; Wielgosz A6 ; Lear S7 ; Alhabib KF8 ; Co HU9 ; Lopezjaramillo P10 ; Avezum A11 ; Seron P12 Show All Authors
Authors
  1. Rajan S1, 2
  2. Mckee M1
  3. Rangarajan S2
  4. Bangdiwala S2
  5. Rosengren A3
  6. Gupta R4
  7. Kutty VR5
  8. Wielgosz A6
  9. Lear S7
  10. Alhabib KF8
  11. Co HU9
  12. Lopezjaramillo P10
  13. Avezum A11
  14. Seron P12
  15. Oguz A13
  16. Kruger IM14
  17. Diaz R15
  18. Nafiza MN16
  19. Chifamba J17
  20. Yeates K18
  21. Kelishadi R19
  22. Sharief WM20
  23. Szuba A21
  24. Khatib R22, 23
  25. Rahman O24
  26. Iqbal R25
  27. Bo H26
  28. Yibing Z26
  29. Wei L26
  30. Yusuf S2
Show Affiliations
Authors Affiliations
  1. 1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, United Kingdom
  2. 2. Population Health Research Institute, Hamilton Health Sciences McMaster University, Hamilton, ON, Canada
  3. 3. Department of Molecular and Clinical Medicine Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Sweden
  4. 4. Eternal Heart Care Centre, Research Institute, Jaipur, India
  5. 5. Health Action by People, Trivandrum, India
  6. 6. Department of Medicine, University of Ottawa, ON, Canada
  7. 7. Faculty of Health Sciences, Simon Fraser University, Division of Cardiology Providence Health Care, Vancouver, BC, Canada
  8. 8. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  9. 9. University of the Philippines, College of Medicine, Manila, Philippines
  10. 10. Masira Research Institute, Medical School, Universidad de Santander, FOSCAL, Bucaramanga, Colombia
  11. 11. Department of Medicine, Universidade de Santo Amaro, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
  12. 12. Universidad de la Frontera, Temuco, Chile
  13. 13. Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
  14. 14. Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  15. 15. Estudios Clinicos Latinoamerica (ECLA), Rosario, Santa Fe, Argentina
  16. 16. Faculty of Medicine, UiTM, Malaysia
  17. 17. University of Zimbabwe College of Health Sciences, Department of Physiology, Harare, Zimbabwe
  18. 18. Department of Medicine, Queen's University, Kingston, ON, Canada
  19. 19. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  20. 20. Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai, United Arab Emirates
  21. 21. Department of Angiology, Wroclaw Medical University, Poland
  22. 22. Advocate Research Institute, Advocate Health Care, Downers Grove, IL, United States
  23. 23. Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
  24. 24. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  25. 25. Independent University, Dhaka, Bangladesh
  26. 26. National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China

Source: JAMA Psychiatry Published:2020


Abstract

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- A nd 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 145862 participants, 61235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15983 (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.. © 2020 American Medical Association. All rights reserved.
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