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

Published online by Cambridge University Press:  11 June 2020

Francisco T. T. Lai Open the ORCID record for Francisco T. T. Lai [Opens in a new window] ,
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  and
Eliza L. Y. Wong
...Show all authors
Francisco T. T. Lai
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Stewart W. Mercer
Affiliation:
Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
Bruce Guthrie
Affiliation:
Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
Benjamin H. K. Yip
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Gary K. K. Chung
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Dan Zou
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Kam-Pui Lee
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Patsy Y. K. Chau
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Roger Y. Chung
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Eliza L. Y. Wong
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Eng-Kiong Yeoh
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
Samuel Y. S. Wong*
Affiliation:
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
*
Author for correspondence: Samuel Y. S. Wong, E-mail: yeungshanwong@cuhk.edu.hk
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Abstract

Background

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.

Keywords

Cerebrovascular diseaseChronic diseasemental disordermultimorbiditypsychiatric comorbidity
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 2 , January 2022 , pp. 283 - 291
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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