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.本研究旨在达成三项核心研究目标：其一，比较伴与不伴脊髓损伤（Spinal Cord Injury, SCI）的成人群体中焦虑/抑郁障碍与超重/肥胖的患病率；其二，分析上述两类病症的多重共病发生情况；其三，探究伴脊髓损伤的超重/肥胖个体，相较于同群体中体重正常者，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岁及以上成人，最终共纳入761598名研究对象，其中3136名被诊断为脊髓损伤。所有研究对象的脊髓损伤、焦虑和/或抑郁障碍以及超重/肥胖的诊断均依据国际疾病分类（International Classification of Diseases）标准，研究采用逻辑回归（logistic regression）计算年龄校正后的比值比（Odds Ratios, ORs）。结果显示，与无脊髓损伤的个体相比，脊髓损伤群体罹患焦虑障碍（OR=3.58，95%置信区间（95% Confidence Interval, 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；在共病分析层面，相较于无脊髓损伤的群体，脊髓损伤群体同时罹患超重/肥胖与焦虑障碍（OR=4.30，95%CI[3.71–4.98]）、超重/肥胖与抑郁障碍（OR=4.69，95%CI[4.01–5.47]）的比值同样显著升高。进一步针对脊髓损伤群体的亚组分析显示，该群体中超重/肥胖个体罹患焦虑障碍（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，相较于同群体内体重正常者显著升高。本研究是首批证实脊髓损伤群体同时罹患超重/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这类相互关联的共病的临床诊疗提供了重要参考。