Quantifying depressive symptoms on incidence of common chronic diseases and multimorbidity patterns in middle-aged and elderly Chinese adults

Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified. For this cohort analysis, we included 9024–14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms. Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05–1.26) to 1.64 (1.38–1.96) and 5% (0–10%) to 17% (6–28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11–1.42), 1.34 (1.07–1.69), 1.45 (1.29–1.63), and 2.01 (1.36–2.96), and respective PAFs (95% CIs) of 5% (0–10%), 8% (˗4–21%), 12% (7–17%), and 20% (5–35%). Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese.