The association between depressive symptoms and metabolic syndrome among the middle-aged and elderly populations in China
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摘要:
目的 分析中国中老年人抑郁症状对代谢综合征(metabolic syndrome, MS)患病的影响。 方法 选取2015年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据库中重要变量完整的6 963名年龄≥45岁的中老年人为研究对象，采用简版流调中心抑郁水平评定量表(the center for epidemiological studies depression scale, CES-D10)评估抑郁症状，根据2020年中华医学会糖尿病学分会(Chinese Diabetes Society, CDS)提出的诊断标准评估MS的患病情况。采用倾向性评分匹配法，在均衡潜在混杂因素的基础上估计抑郁症状对中国中老年人MS患病的平均处理效应(average treatment effect on the treated, ATT)，以探究抑郁症状对MS影响。 结果 6 963例研究对象中，有33.10%(95% CI: 32.00%~34.21%)的中老年人存在抑郁症状，MS检出率为18.44%(95% CI: 17.53%~19.35%)。经倾向性评分均衡混杂因素后发现，抑郁症状对中老年人是否患MS没有影响(ATT=-0.002~0.002，均P>0.05)。 结论 中国中老年人群的抑郁症状和MS检出率较高，但有抑郁症状与该人群是否患MS无明显关联。 Abstract:Objective The objective of the study was to analyze the impact of depressive symptoms on metabolic syndrome (MS) in middle-aged and older Chinese adults. Methods A total of 6 963 people aged ≥45 years with complete and important variables from the China Health and Retirement Longitudinal Survey (CHARLS) database in 2015 were extracted. Depressive symptoms were assessed using the center for epidemiological studies of depression (CES-D10) scale. MS was defined under the diagnostic criteria proposed by China Diabetes Society (CDS) in 2020. To analyze the association between depressive symptom and MS, propensity score matching was performed to control for potential bias, and the average treatment effect on the treated (ATT) between groups was estimated to verify the effect of depressive symptoms on MS. Results Among the 6 963 subjects, 33.10% (95% CI: 32.00%-34.21%) of middle-aged and older adults had depressive symptoms, and the detection rate of MS was 18.44% (95% CI: 17.53%-19.35%). After adjusting for potential confounders by propensity score matching, no significant association was observed between depressive symptoms and MS in middle-aged and older adults (ATT=-0.002-0.002, all P>0.05). Conclusions In the middle-aged and elderly population in China, both depressive symptoms and MS were detected at high rates, but having depressive symptoms was not significantly associated with the presence of MS in this population. -
表 1 不同特征变量下中老年人抑郁症状及MS检出率
Table 1. Depressive symptoms and MS detection rate among the middle-aged and elderly population grouped by different covariates
变量Variable 赋值Value 例数
Number of people抑郁症状Depressive symptoms 代谢综合征Metabolic syndrome 人数(占比%)
Number of people
(proportion /%)χ2值
valueP值
value人数(占比%)
Number of people
(proportion /%)χ2值
valueP值
value年龄组/岁Age group/year 5.51 0.060 4.63 0.100 45~ < 60 0 3 281 1 043(31.79) 582(17.74) 60~ < 75 1 3 195 1 103(34.52) 622(19.47) ≥75 2 487 159(32.65) 80(16.43) 性别Gender 173.73 < 0.001 3.68 0.060 男性Male 0 3 297 833(25.27) 577(17.50) 女性Female 1 3 666 1 472(40.15) 707(19.29) 与配偶同居Living with spouse 47.54 < 0.001 2.88 0.090 否No 0 1 084 457(42.16) 180(16.61) 是Yes 1 5 879 1 848(31.43) 1 104(18.78) 居住地Residence 88.79 < 0.001 45.07 < 0.001 城市Urban 0 1 637 385(23.52) 394(24.07) 农村Rural 1 5 326 1 920(36.05) 890(16.71) 文化程度Education level 207.26 < 0.001 13.51 < 0.001 文盲Illiteracy 0 1 614 707(43.80) 287(17.78) 小学Primary school 1 2 949 1 051(35.64) 499(16.92) 初中及以上Middle school or above 2 2 400 547(22.79) 498(20.75) 目前吸烟Current smoker 37.93 < 0.001 0.98 0.320 否No 0 4 090 1 473(36.02) 770(18.83) 是Yes 1 2 873 832(28.96) 514(17.89) 目前饮酒Current alcohol drinker 63.06 < 0.001 10.38 < 0.001 否No 0 4 463 1 627(36.46) 873(19.56) 是Yes 1 2 500 678(27.12) 411(16.44) 夜间睡眠时长/h Sleep duration at night/h 359.01 < 0.001 1.88 0.390 < 6 0 2 144 1 053(49.11) 375(17.49) 6~ < 9 1 4 179 1 093(26.16) 787(18.83) ≥9 2 640 159(24.84) 122(19.06) 心血管病史History of cardiovascular disease 64.29 < 0.001 67.15 < 0.001 否No 0 5 820 1 810(31.10) 975(16.75) 是Yes 1 1 143 495(43.31) 309(27.03) 合计Total 6 963 2 305(33.10) 1 284(18.44) 
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表 2 协变量偏差消减情况
Table 2. The bias reduction status of covariates
协变量Covariates 匹配情况
Matching Status均值Mean 标准差值/%
Bias/%偏差消减/%
Reduction in bias/%t检验test 抑郁症状组
Depressive symptoms group非抑郁症状组
No depressive symptoms groupt值
valueP值
value年龄/岁Age/years U 0.67 0.59 4.30 1.69 0.09 M 0.62 0.63 -1.40 66.40 -0.49 0.62 性别Gender U 0.64 0.47 34.20 13.35 < 0.01 M 0.64 0.65 -3.20 90.70 -1.10 0.27 婚姻状况Marital status U 0.80 0.87 -17.20 -6.92 < 0.01 M 0.80 0.83 -7.90 54.10 -2.57 0.01 居住地Residence U 0.83 0.73 24.80 9.48 < 0.01 M 0.83 0.84 -1.60 93.60 -0.60 0.55 文化程度Education level U 0.93 1.20 -36.90 -14.46 < 0.01 M 0.93 0.94 -0.40 98.80 -0.14 0.89 吸烟Smoking U 0.36 0.44 -15.80 -6.18 < 0.01 M 0.36 0.34 3.40 78.70 1.17 0.24 饮酒Alcohol drinking U 0.29 0.39 -20.50 -7.98 < 0.01 M 0.29 0.29 0.90 95.50 0.33 0.74 夜间睡眠时长/h Sleep duration at night/h U 0.61 0.87 -43.50 -17.33 < 0.01 M 0.61 0.60 2.00 95.30 0.67 0.50 心血管病History of cardiovascular disease U 0.22 0.14 19.90 8.05 < 0.01 M 0.21 0.20 3.40 82.80 1.09 0.28 注：U, 匹配前; M, 匹配后。
Notes: U, Before the match; M, After the match.
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表 3 共同支撑检验
Table 3. Common support assumption test
变量Variable 不在共同取值范围内Off support 在共同取值范围内On support 合计Total 抑郁症状组Depressive symptoms 5 2300 2 305 非抑郁症状组No depressive symptoms 11 4 647 4 658 合计Total 16 6947 6 963
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表 4 中老年人抑郁症状和MS关联效应的ATT估计结果
Table 4. The estimated results of ATT on the associated effects of depressive symptoms and MS in middle-aged and older adults
匹配方式
Matching methods有抑郁症状
Depressive symptoms无抑郁症状
No depressive symptomsATT s t值
valueP值
value卡尺内k近邻匹配K-nearest neighbor matching 0.184 0.186 -0.002 0.021 -0.08 >0.05 半径匹配Radius matching 0.184 0.184 0.000 0.011 0.01 >0.05 核匹配Kernel matching 0.184 0.182 0.002 0.011 0.17 >0.05 注：MS, 代谢综合征; ATT, 处理组平均处理效应。
Notes: MS, metabolic syndrome; ATT, average treatment effect on the treated.
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