摘要
目的 分析我国社区中老年人群抑郁症与髋部骨折的相关性.方法 研究数据来源于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据库,选择2018年第四次全国追访数据中1.24万户家庭中的16 831例受访者为研究样本.将样本按7∶3分为训练集和测试集,利用测试集数据进行内部验证;外部验证选取2018至2023年浙江中医药大学附属第一医院骨伤研究所招募的2 337例受试者为调查对象.抑郁症评估采用流行病学研究中心抑郁量表(the Center for Epidemiological Studies Depression Scale,CESD),CESD≥16 分定义为抑郁症,CESD＜16 分定义为无抑郁症.采用二分类logistic回归调整不同协变量,逐步分析抑郁症与髋部骨折的相关性.结果 训练集中发生与未发生髋部骨折患者合并抑郁症的比例(x2=16.310,P＜0.001)、年龄(x2=9.417,P=0.009)、文化程度(P＜0.001)、婚姻状况(P=0.019)、居住地(P=0.035)的差异有统计学意义;测试集中发生与未发生髋部骨折患者合并抑郁症的比例(x2=10.130,P=0.001)、性别(x2=4.368,P=0.037)、文化程度(P=0.013)、吸烟史(x2=8.804,P=0.012)的差异有统计学意义;外部验证集中发生与未发生髋部骨折患者合并抑郁症的比例(x2=337.885,P＜0.001)、年龄(x2=29.475,P＜0.001)、吸烟史(P=0.020)的差异有统计学意义.在控制了人口学特征、锻炼情况、吸烟及饮酒史后,二分类logistic回归结果显示训练集抑郁症患者发生髋部骨折的风险是非抑郁症患者的1.78倍(OR=1.78,P＜0.001),测试集抑郁症患者发生髋部骨折的风险是非抑郁症患者的2.73倍(OR=2.73,P=0.002),外部验证集抑郁症患者发生髋部骨折的风险是非抑郁症患者的15.21倍(OR=15.21,P＜0.001),提示内部验证和外部验证结果良好.结论 我国社区中老年人群中抑郁症是导致髋部骨折的独立危险因素.早期识别中老年人群抑郁情况并进行积极干预有助于降低髋部骨折的发生风险.
Abstract
Objective To analyse the correlation between depression and hip fracture in the middle-aged and elderly population in the Chinese community.Methods The study data were obtained from the China Health and Retirement Longitudi-nal Study(CHARLS)database.A total of 16,831 respondents from 12,400 households in the fourth national follow-up data in 2018 were selected as the research sample.The samples were divided into a training set and a test set at a ratio of 7∶3,and the test set data were used for internal validation.For external validation,2,337 subjects recruited from the Institute of Orthopaedics,the First Affiliated Hospital of Zhejiang Chinese Medical University from 2018 to 2023 were selected as the survey subjects.The Center for Epidemiological Studies Depression Scale(CESD)was used to assess depression.CESD≥16 points were defined as depression,and CESD＜16 points were defined as no depression.Binary logistic regression was used to gradually analyze the correlation be-tween depression and hip fracture after adjusting for different covariates.Results In the training set,statistically significant dif-ferences were observed between patients with and without hip fractures in terms of depression prevalence(x2=16.310,P＜0.001),age(x2=9.417,P=0.009),education level(P＜0.001),marital status(P=0.019),and place of residence(P=0.035).In the testing set,statistically significant differences were found in depression prevalence(x2=10.130,P=0.001),gender(x2=4.368,P=0.037),educa-tion level(P=0.013),and smoking history(x2=8.804,P=0.012).In the external validation set,significant differences were noted in depression prevalence(x2=337.885,P＜0.001),age(x2=29.475,P＜0.001),and smoking history(P=0.020).After controlling for de-mographic characteristics,exercise,smoking and drinking history,binary logistic regression showed that the risk of hip fracture in depressed patients was 1.78 times higher in the training set(OR=1.78,P＜0.001),2.73 times higher in the testing set(OR=2.73,P=0.002),and 15.21 times higher in the external validation set(OR=15.21,P＜0.001)than that of non-depressed patients,indicating good internal and external validation results.Conclusion Depression is an independent risk factor for hip fractures among mid-dle-aged and elderly populations in Chinese communities.Early identification and active intervention for depression in this popula-tion can help reduce the risk of hip fractures.
维普
万方数据