Longitudinal trajectories of depressive symptoms and respiratory health risk in middle-aged and older Chinese adults: A nationally representative prospective landmark cohort study.
BACKGROUND Depressive symptoms are dynamic, but their longitudinal patterns in relation to chronic respiratory disease (CRD) remain unclear. We examined whether depressive symptom trajectories were associated with incident CRD in middle-aged and older Chinese adults. METHODS Data from the China Health and Retirement Longitudinal Study were analyzed using a 2015 landmark design. Depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression Scale in 2011, 2013, and 2015 among participants free of self-reported physician-diagnosed CRD through 2015. Incident CRD was assessed in 2018 and 2020. Group-based trajectory modeling was used to identify symptom patterns, and multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Among 7261 participants, 611 (8.4%) developed CRD. Five trajectories were identified: low-stable (64.4%), decreasing (12.1%), fluctuating (5.3%), increasing (11.2%), and high-stable (7.0%). Compared with the low-stable group, all four non-low-stable trajectories were associated with higher odds of incident CRD after full adjustment (ORs 1.32-2.32), with the strongest association in the high-stable group (OR 2.32, 95% CI 1.75-3.06). At single assessments, 14.1%-18.6% of participants with CES-D-10 scores <10 belonged to non-low-stable trajectories. Associations were broader for CRD and chronic lung disease than for asthma. Persistently high somatic and affective-cognitive trajectories were also associated with CRD and chronic lung disease. Findings were robust in sensitivity analyses. CONCLUSION Depressive symptom trajectories were associated with CRD and captured heterogeneity not fully reflected by single-time assessments. Repeated assessment may help identify middle-aged and older adults at elevated respiratory risk.