Association Between Depressive Symptoms and Risk of New-Onset Chronic Liver Disease Among Middle-Aged and Elderly Chinese Adults: A Prospective Cohort Study Based on the China Health and Retirement Longitudinal Study.
慢性肝病（CLD）在全球范围内造成沉重负担，尤其在中年和老年人群中。关于抑郁症状是否独立预测新发CLD的前瞻性证据仍然匮乏。本前瞻性队列研究使用CHARLS（2011—2020）数据，纳入9549名基线无CLD的参与者。采用CES-D-10评估抑郁症状，并分为四个严重程度等级。使用多变量Cox回归、Kaplan-Meier分析和ROC曲线进行分析。按人口学和行为学分层进行亚组分析以评估一致性。在平均8.77年的随访期间，746名（7.8%）参与者发生新发CLD。基线抑郁严重程度越高，CLD风险越高。在完全调整模型中，与非抑郁组相比，轻度抑郁的HR为1.34（95% CI：1.12-1.59，= 0.001），中度抑郁为1.65（95% CI：1.34-2.04，< 0.001），重度抑郁为2.16（95% CI：1.26-3.72，= 0.005）。累积发病率随抑郁严重程度增加而升高，且组间差异随时间扩大（log-rank < 0.0001）。亚组分析显示，不同人口学和行为学分层中的关联一致。在总人群中，分析一致表明基线抑郁症状严重程度与新发CLD之间存在独立的、分级关联，且在多变量调整后持续存在。分层分析进一步揭示，该关联主要由女性参与者和中年成人（45—60岁）驱动，突出这些亚组为基于抑郁的CLD预防和筛查策略的优先人群。
Chronic liver disease (CLD) imposes a heavy global burden, particularly among middle-aged and elderly adults. Prospective evidence on whether depressive symptoms independently predict new-onset CLD remains scarce. This prospective cohort study used CHARLS (2011-2020) data and enrolled 9549 participants without baseline CLD. Depressive symptoms were assessed using the CES-D-10 and categorized into four severity levels. Multivariable Cox regression, Kaplan-Meier analysis, and ROC curves were used. Subgroup analyses were conducted across demographic and behavioral strata to assess consistency. During a mean follow-up of 8.77 years, 746 (7.8%) participants developed new-onset CLD. Higher baseline depression severity was associated with increased CLD risk. In the fully adjusted model, compared with the non-depressed group, the HR for mild depression was 1.34 (95% CI: 1.12-1.59, = 0.001), for moderate depression 1.65 (95% CI: 1.34-2.04, < 0.001), and for severe depression 2.16 (95% CI: 1.26-3.72, = 0.005). Cumulative incidence increased with depression severity, with group differences widening over time (log-rank < 0.0001). Subgroup analyses showed consistent associations across different demographic and behavioral strata. Across the total population, the analyses consistently demonstrate an independent, graded association between baseline depressive symptom severity and incident CLD that persists after multivariable adjustment. The stratified analyses further reveal that this association is primarily driven by female participants and middle-aged adults (45-60 years), highlighting these subgroups as priority populations for depression-informed CLD prevention and screening strategies.
Tiancheng Meng, Yanling Jiang, Guolin Guo, Jianteng Dong, Xiaofan Lai, Jiale Liu, et al. Association Between Depressive Symptoms and Risk of New-Onset Chronic Liver Disease Among Middle-Aged and Elderly Chinese Adults: A Prospective Cohort Study Based on the China Health and Retirement Longitudinal Study.. Healthcare (Basel, Switzerland). 2026; doi:10.3390/healthcare14131986.
Tiancheng Meng, Yanling Jiang, Guolin Guo, Jianteng Dong, Xiaofan Lai, Jiale Liu, et al (2026). Association Between Depressive Symptoms and Risk of New-Onset Chronic Liver Disease Among Middle-Aged and Elderly Chinese Adults: A Prospective Cohort Study Based on the China Health and Retirement Longitudinal Study.. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare14131986
Tiancheng Meng, Yanling Jiang, Guolin Guo, Jianteng Dong, Xiaofan Lai, Jiale Liu, et al. Association Between Depressive Symptoms and Risk of New-Onset Chronic Liver Disease Among Middle-Aged and Elderly Chinese Adults: A Prospective Cohort Study Based on the China Health and Retirement Longitudinal Study.[J]. Healthcare (Basel, Switzerland), 2026 doi:10.3390/healthcare14131986.
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