Sociodemographic moderation of the association between depression and stroke incidence in a retrospective cohort of 0.4 million primary care recipients with hypertension
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Officially Accepted for Publication


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AbstractBackground
Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.

Methods
We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007–December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011–2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430–437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.

Results
In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03–1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00–1.67).

Conclusion
Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
Acceptance Date20/05/2020
All Author(s) ListFrancisco T. T. Lai , Stewart W. Mercer, Bruce Guthrie, Benjamin H. K. Yip, Gary K. K. Chung, Dan Zou, Kam-Pui Lee, Patsy Y. K. Chau, Roger Y. Chung, Eliza L. Y. Wong, Eng-Kiong Yeoh, Samuel Y. S. Wong
Journal namePsychological Medicine
Year2020
PublisherCambridge University Press
Place of PublicationCambridge, United Kingdom
ISSN0033-2917
LanguagesEnglish-United Kingdom
KeywordsCerebrovascular disease, Chronic disease, mental disorder, multimorbidity, psychiatric comorbidity

Last updated on 2020-26-10 at 00:01