Abstract: Background　Stroke has become a leading cause of death in China. Whether depression is an independent risk factor for stroke remains controversial，and it is noteworthy to determine the relationship between them. Objective　To assess the association of baseline depressive symptoms with stroke risk among middle-aged and older Chinese adults. Methods　Data derived from the CHARLS conducted in 2011，2013 and 2015 were obtained from March to December 2019. 12 645 respondents aged 45 or over were enrolled and their demography，lifestyle，health status，depression and stroke history were collected. According to the prevalence of depression，they were divided into depression and non-depression groups. Multivariate Logistic regression analyses were carried out to assess the relationship between stroke outcome and baseline depression detected in 2011. Results　4 675（36.97%） participants had depressive symptoms at baseline. 174 cases（1.38%） reported stroke incidents during the follow-up period，including 77（1.65%） with baseline depressive symptoms and 97（1.22%） without. Multivariate Logistic regression analyses showed that the OR with 95%CI of stroke risk in those with baseline depression was〔1.489（1.084，2.046），P=0.014〕 with adjustment of age，sex，marital status，education，and income. After adjusting for smoking，drinking，BMI，hypertension，blood lipid abnormality，depression was the risk factor of stroke, and the difference was statistically significant〔OR（95%CI）=1.444（1.009，2.065），P=0.044〕. After adjusting for all potential confounders, moderate and severe depression was not a risk factor for stroke compared with no/ground depression risk〔OR（95%CI）=1.374（0.938，2.011），OR（95%CI）=1.834（0.994，3.833），P>0.05〕. Conclusion　Depressive symptom may be an independent risk factor of stroke risk. Closely focusing on the depressive symptoms and incentivizing the screening of depression in primary care may be useful ways to reduce the incidence of stroke in middle-aged and elderly people.

Key words: Mid-aged and older population, Depression, Stroke, Root cause analysis, Cohort study

摘要： 背景　当前脑卒中已经是我国的首要致死病因，而抑郁是否是脑卒中的独立危险因素尚存争议，研究抑郁是否为脑卒中的危险因素很有必要性。目的　研究我国中老年人基线抑郁症状对脑卒中发病的影响。方法　于2019年3—12月，基于中国健康与养老追踪调查（CHARLS）2011、2013、2015年3年随访数据，从中选取12 645例≥45岁的中老年人为研究对象。收集研究对象的一般信息、生活习惯、健康状况、抑郁和随访期间脑卒中患病情况。根据有无抑郁状态分为无抑郁组和抑郁组。采用Logistic回归模型分析2011年基线抑郁状态与随访期间脑卒中发病风险之间的关系。结果　基线时共有4 675例（36.97%）有抑郁症状，随访期内共有174例（1.38%）有脑卒中发作，其中无抑郁组97例（1.22%），抑郁组有77例（1.65%）。控制年龄、性别、婚姻状况、文化程度、个人月收入后，抑郁是脑卒中发病的危险因素〔OR（95%CI）＝1.489（1.084，2.046），P=0.014〕；进一步调整吸烟、饮酒、体质指数（BMI）、高血压、血脂异常后，抑郁是脑卒中发病的危险因素〔OR（95%CI）=1.444（1.009，2.065），P=0.044〕。调整所有潜在混杂因素后，与无/低抑郁风险相比，中、重度抑郁风险不增加脑卒中发病风险〔OR（95%CI）=1.374（0.938，2.011），OR（95%CI）=1.834（0.994，3.833），P>0.05〕。结论　我国中老年人抑郁症状是脑卒中的独立危险因素，建议关注中老年人的抑郁症状，鼓励基层卫生服务机构开展抑郁症状筛查，可能有助于降低脑卒中的发病率。

关键词: 中老年人群, 抑郁, 卒中, 影响因素分析, 队列研究