The association between depression and cardiometabolic multimorbidity in Chinese middle-aged and elderly people: findings from a national longitudinal cohort

BACKGROUND Cardiometabolic multimorbidity (CMM) has emerged as a significant public health concern. Prior research has found the associations between depression and cardiometabolic diseases (CMD). However, the studies about the association between depression and CMM were limited. METHODS This study was designed as a prospective observational investigation. The study population comprised middle-aged and older adults who participated in the CHARLS in 2011 and follow-up in 2018, with no CMD at baseline. Depressive symptoms were assessed using the CESD-10 scale. The multivariable Cox proportional hazards model was employed to evaluate the association between depression and the risk of CMM. RESULTS The study included 9084 participants, with a mean age of 57.69 years. Among them, 3116 individuals were diagnosed with depression. Over a 7-year follow-up period, 431 participants (4.74%) developed CMM. Multivariable Cox proportional hazards regression revealed that participants with depression had a 1.65-fold heightened risk of CMM (HR:2.65, 95%CI: 1.95, 3.61), 0.84-fold in heart disease (HR:1.84, 95%CI: 1.49, 2.26), 0.58-fold in stroke (HR:1.58, 95%CI: 1.16, 2.16), and 0.48-fold in diabetes (HR:1.48, 95%CI: 1.19, 1.85) compared to those without. And the risk of CMM increased progressively with greater severity of depression. Subgroup analysis revealed that depression significantly increased CMM risk in individuals without hypertension (p for interaction = 0.025). The Kaplan-Meier curves indicated that individuals with depression exhibit a higher cumulative incidence of CMM, which further increased with greater severity of depression. CONCLUSION The findings of this study revealed that depression not only significantly heightened the risk of CMD but also the risk of CMM. Furthermore, the risk of CMM rose progressively with greater severity of depressive degree, highlighting the pivotal role of depression in both the onset and progression of cardiometabolic disorders.