Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury

To compare the prevalence of anxiety/depression and overweight/obesity (Aim 1) and the multimorbidity of these conditions (Aim 2) in a sample of adults with and without spinal cord injury (SCI). Aim 3 was to examine whether overweight/obese individuals with SCI differ on the prevalence of anxiety/depressive disorders compared to non-overweight/obese individuals with SCI. Retrospective cohort study. Individuals ≥16 years old who had patient encounters between January 1, 2011, and February 28, 2018. In total, 761 598 individuals were included, of which 3136 had SCI. Individuals were identified as diagnosed with SCI, anxiety and/or depressive disorders, and overweight/obesity using the International Classification of Diseases. Age-adjusted odds ratios (ORs) were calculated using logistic regression. In contrast to non-SCI individuals, those with SCI had increased odds of anxiety disorders (OR: 3.58, 95% CI [3.29–3.90]), depressive disorders (OR: 4.33, 95% CI [3.95–4.74]), and overweight/obesity (OR: 3.08, 95% CI [2.80–3.38]). Pertaining to multimorbidity, individuals with SCI had increased odds of having overweight/obesity alongside anxiety disorders (OR: 4.30, 95% CI [3.71–4.98]) and overweight/obesity alongside depressive disorders (OR: 4.69, 95% CI [4.01–5.47]) compared to those without SCI. Individuals with SCI who were diagnosed as overweight/obese had increased odds of having anxiety disorders (OR: 2.54, 95% CI [2.06–3.13]), and depressive disorders (OR: 2.70, 95% CI [2.18–3.36]), relative to non-overweight/obese individuals with SCI. This work is among the first to find evidence that individuals with SCI are at heightened odds of overweight/obesity alongside anxiety and/or depressive disorders. This early work holds clinical implications for treating these interrelated comorbidities in SCI.

本研究旨在对比伴与不伴脊髓损伤（Spinal Cord Injury, SCI）的成年人群中焦虑/抑郁症状及超重/肥胖的流行率（目标1），并分析此类多重共病的发生情况（目标2）；目标3则为探究伴脊髓损伤的超重/肥胖人群，与伴脊髓损伤的非超重/肥胖人群相比，其焦虑/抑郁障碍的患病率是否存在差异。本研究为回顾性队列研究，纳入2011年1月1日至2018年2月28日期间存在就诊记录的16岁及以上成年人，最终共纳入761598名受试者，其中3136名确诊脊髓损伤。研究通过国际疾病分类（International Classification of Diseases）标准识别确诊脊髓损伤、焦虑和/或抑郁障碍以及超重/肥胖的受试者，并采用logistic回归计算年龄校正后的比值比（Odds Ratios, ORs）。结果显示，与非脊髓损伤受试者相比，脊髓损伤受试者罹患焦虑障碍（OR: 3.58, 95% CI [3.29–3.90]）、抑郁障碍（OR: 4.33, 95% CI [3.95–4.74]）以及超重/肥胖（OR: 3.08, 95% CI [2.80–3.38]）的比值均显著升高。针对多重共病情况，相较于非脊髓损伤受试者，脊髓损伤受试者同时罹患超重/肥胖与焦虑障碍（OR: 4.30, 95% CI [3.71–4.98]）、以及同时罹患超重/肥胖与抑郁障碍（OR: 4.69, 95% CI [4.01–5.47]）的比值均显著升高。进一步分析显示，在脊髓损伤受试者中，超重/肥胖人群罹患焦虑障碍（OR: 2.54, 95% CI [2.06–3.13]）与抑郁障碍（OR: 2.70, 95% CI [2.18–3.36]）的比值，显著高于非超重/肥胖的脊髓损伤受试者。本研究是首批证实脊髓损伤受试者同时罹患超重/肥胖与焦虑和/或抑郁障碍的风险显著升高的研究之一，此项前期研究成果为脊髓损伤患者此类相互关联的共病治疗提供了临床启示。