A prospective cohort study of time-updated discrepancies between subjective and objective health and incident depressive symptoms in Chinese middle-aged and older adults

doi:10.3969/j.issn.1004-583X.2026.10.003

Abstract

Abstract:

Objective To examine the prospective effect of time-updated discrepancies between subjective and objective health on incident depression in Chinese middle-aged and older adults. Methods Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020), 6 193 middle-aged and older participants aged ≥50 years without depression at baseline were included (15 892 person-periods). Four time-updated phenotypes were defined by self-rated health and chronic disease comorbidity. A discrete-time complementary log-log survival model was used to evaluate the risk of depression. Results During follow-up, 2 845 incident depression cases occurred. In the fully adjusted model, compared with the group with good self-rated health and no comorbidity, the risk of incident depression was significantly increased in the group with poor self-rated health and no comorbidity (HR=1.54, 95%CI: 1.39-1.71), the group with good self-rated health but with comorbidity (HR=1.40, 95%CI: 1.14-1.71), and the group with poor self-rated health and comorbidity (HR=2.11, 95%CI: 1.88-2.36). No significant interactions were observed across clinical subgroups (all interaction P>0.05). Conclusion Health phenotypes were associated with incident depressive symptoms; the highest risk was observed among individuals with both poor self-rated health and multimorbidity. Joint evaluation of subjective and objective health may help identify individuals at elevated risk of depressive symptoms.

Key words: self-rated health, chronic disease multimorbidity, health discordance, depressive symptoms, prospective cohort study

CLC Number:

R749.4
R592

Wang Qilong, Qi Xin, Zhao Dongrong. A prospective cohort study of time-updated discrepancies between subjective and objective health and incident depressive symptoms in Chinese middle-aged and older adults[J]. Clinical Focus, 2026, 41(10): 881-890.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.10.003

https://www.lchc.cn/EN/Y2026/V41/I10/881

Figures/Tables 8

References 30

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特征指标		总体 (N=6157)		自评良好-无共病 (n=1 614)		自评不良-无共病 (n=3 242)		自评良好-伴共病 (n=202)	自评不良-伴共病 (n=1099)	统计量		P值
例数[例(%)]		6 157(100.0)		1 614(26.2)		3 242(52.7)		202(3.3)	1 099(17.8)	-		-
年龄(岁)		61.5±7.9		60.7±7.7		61.2±7.8		63.5±8.8	63.4±7.7	F=34.60		<0.001
年龄分段[例(%)]										χ²=81.43		<0.001
<65岁		4 230(68.7)		1 182(73.2)		2 285(70.5)		120(59.4)	643(58.5)
≥65岁		1 927(31.3)		432(26.8)		957(29.5)		82(40.6)	456(41.5)
性别[例(%)]										χ²=27.65		<0.001
男		2 764(44.9)		660(40.9)		1 446(44.6)		100(49.5)	558(50.8)
女		3 393(55.1)		954(59.1)		1 796(55.4)		102(50.5)	541(49.2)
受教育程度[例(%)]										χ²=17.21		0.009
初中及以下		5 359(87.0)		1 371(84.9)		2 847(87.8)		173(85.6)	968(88.1)
高中/中专		676(11.0)		203(12.6)		343(10.6)		20(9.9)	110(10.0)
大专及以上		122(2.0)		40(2.5)		52(1.6)		9(4.5)	21(1.9)
家庭人均年收入[例(%)]										χ²=32.57		<0.001
低收入组		2 058(33.4)		514(31.8)		1 125(34.7)		59(29.2)	360(32.8)
中等收入组		2 052(33.3)		507(31.4)		1 134(35.0)		55(27.2)	356(32.4)
高收入组		2 047(33.2)		593(36.7)		983(30.3)		88(43.6)	383(34.8)
在业状态[例(%)]										χ²=150.06		<0.001
非在业		2 306(37.5)		525(32.5)		1 110(34.2)		86(42.6)	585(53.2)
在业		3 851(62.5)		1 089(67.5)		2 132(65.8)		116(57.4)	514(46.8)
婚姻状况[例(%)]										χ²=10.96		0.012
无伴侣(离异/丧偶/未婚)		661(10.7)		179(11.1)		314(9.7)		23(11.4)	145(13.2)
已婚/有伴侣		5 496(89.3)		1 435(88.9)		2 928(90.3)		179(88.6)	954(86.8)
与子女同住情况[例(%)]										χ²=11.74		0.008
否		2 696(43.8)		714(44.2)		1 367(42.2)		104(51.5)	511(46.5)
是		3 461(56.2)		900(55.8)		1 875(57.8)		98(48.5)	588(53.5)
体质量指数(BMI, kg/m²)		23.6±3.7		23.6±3.6		22.9±3.6		25.2±3.9	25.0±4.0	F=102.60		<0.001
体质量分类[例(%)]										χ²=225.49		<0.001
正常(18.5~23.9)		3 260(52.9)		869(53.8)		1 900(58.6)		74(36.6)	417(37.9)
消瘦(<18.5)		353(5.7)		72(4.5)		228(7.0)		6(3.0)	47(4.3)
超重/肥胖(≥24.0)		2 544(41.3)		673(41.7)		1 114(34.4)		122(60.4)	635(57.8)
吸烟状况[例(%)]											χ²=44.43	<0.001
否	4 083(66.3)		1 029(63.8)		2 091(64.5)		146(72.3)		817(74.3)
是	2 074(33.7)		585(36.2)		1 151(35.5)		56(27.7)		282(25.7)
饮酒状况[例(%)]											χ²=50.94	<0.001
否	3 936(63.9)		933(57.8)		2 088(64.4)		135(66.8)		780(71.0)
是	2 221(36.1)		681(42.2)		1 154(35.6)		67(33.2)		319(29.0)
高血压[例(%)]											χ²=1 889.99	<0.001
否	4 525(73.5)		1 412(87.5)		2 771(85.5)		48(23.8)		294(26.8)
是	1 632(26.5)		202(12.5)		471(14.5)		154(76.2)		805(73.2)
心脏病[例(%)]											χ²=1 426.44	<0.001
否	5 478(89.0)		1 583(98.1)		3 114(96.1)		142(70.3)		639(58.1)
是	675(11.0)		31(1.9)		128(3.9)		60(29.7)		456(41.5)
糖尿病[例(%)]											χ²=699.89	<0.001
否	5 760(93.6)		1 589(98.5)		3 168(97.7)		153(75.7)		850(77.3)
是	383(6.2)		25(1.5)		74(2.3)		47(23.3)		237(21.6)
脑卒中[例(%)]											χ²=312.72	<0.001
否	6 029(97.9)		1 607(99.6)		3 229(99.6)		190(94.1)		1 003(91.3)
是	126(2.0)		7(0.4)		13(0.4)		12(5.9)		94(8.6)
慢性肺部疾患[例(%)]											χ²=503.90	<0.001
否	5 610(91.1)		1 555(96.3)		3 074(94.8)		163(80.7)		818(74.4)
是	543(8.8)		59(3.7)		168(5.2)		39(19.3)		277(25.2)
恶性肿瘤[例(%)]											χ²=64.86	<0.001
否	6 089(98.9)		1 610(99.8)		3 223(99.4)		196(97.0)		1 060(96.5)
是	61(1.0)		4(0.2)		19(0.6)		5(2.5)		33(3.0)
关节炎/风湿病[例(%)]											χ²=1 024.91	<0.001
否	4 388(71.3)		1 398(86.6)		2 517(77.6)		78(38.6)		395(35.9)
是	1 769(28.7)		216(13.4)		725(22.4)		124(61.4)		704(64.1)
累积慢性病种数[例(%)]											χ²=6 291.62	<0.001
0种	2 714(44.1)		1 070(66.3)		1 644(50.7)		0(0)		0(0.8)
1种	2 142(34.8)		544(33.7)		1 598(49.3)		0(0)		0(0)
≥2种	1 301(21.1)		0(0.0)		0(0.0)		202(100.0)		1 099(100.0)
基线CES-D-10评分(分)	4.5±2.8		3.5±2.7		4.7±2.7		3.9±2.8		5.1±2.7		F=92.40	<0.001

特征指标		总体 (N=6157)		自评良好-无共病 (n=1 614)		自评不良-无共病 (n=3 242)		自评良好-伴共病 (n=202)	自评不良-伴共病 (n=1099)	统计量		P值
例数[例(%)]		6 157(100.0)		1 614(26.2)		3 242(52.7)		202(3.3)	1 099(17.8)	-		-
年龄(岁)		61.5±7.9		60.7±7.7		61.2±7.8		63.5±8.8	63.4±7.7	F=34.60		<0.001
年龄分段[例(%)]										χ²=81.43		<0.001
<65岁		4 230(68.7)		1 182(73.2)		2 285(70.5)		120(59.4)	643(58.5)
≥65岁		1 927(31.3)		432(26.8)		957(29.5)		82(40.6)	456(41.5)
性别[例(%)]										χ²=27.65		<0.001
男		2 764(44.9)		660(40.9)		1 446(44.6)		100(49.5)	558(50.8)
女		3 393(55.1)		954(59.1)		1 796(55.4)		102(50.5)	541(49.2)
受教育程度[例(%)]										χ²=17.21		0.009
初中及以下		5 359(87.0)		1 371(84.9)		2 847(87.8)		173(85.6)	968(88.1)
高中/中专		676(11.0)		203(12.6)		343(10.6)		20(9.9)	110(10.0)
大专及以上		122(2.0)		40(2.5)		52(1.6)		9(4.5)	21(1.9)
家庭人均年收入[例(%)]										χ²=32.57		<0.001
低收入组		2 058(33.4)		514(31.8)		1 125(34.7)		59(29.2)	360(32.8)
中等收入组		2 052(33.3)		507(31.4)		1 134(35.0)		55(27.2)	356(32.4)
高收入组		2 047(33.2)		593(36.7)		983(30.3)		88(43.6)	383(34.8)
在业状态[例(%)]										χ²=150.06		<0.001
非在业		2 306(37.5)		525(32.5)		1 110(34.2)		86(42.6)	585(53.2)
在业		3 851(62.5)		1 089(67.5)		2 132(65.8)		116(57.4)	514(46.8)
婚姻状况[例(%)]										χ²=10.96		0.012
无伴侣(离异/丧偶/未婚)		661(10.7)		179(11.1)		314(9.7)		23(11.4)	145(13.2)
已婚/有伴侣		5 496(89.3)		1 435(88.9)		2 928(90.3)		179(88.6)	954(86.8)
与子女同住情况[例(%)]										χ²=11.74		0.008
否		2 696(43.8)		714(44.2)		1 367(42.2)		104(51.5)	511(46.5)
是		3 461(56.2)		900(55.8)		1 875(57.8)		98(48.5)	588(53.5)
体质量指数(BMI, kg/m²)		23.6±3.7		23.6±3.6		22.9±3.6		25.2±3.9	25.0±4.0	F=102.60		<0.001
体质量分类[例(%)]										χ²=225.49		<0.001
正常(18.5~23.9)		3 260(52.9)		869(53.8)		1 900(58.6)		74(36.6)	417(37.9)
消瘦(<18.5)		353(5.7)		72(4.5)		228(7.0)		6(3.0)	47(4.3)
超重/肥胖(≥24.0)		2 544(41.3)		673(41.7)		1 114(34.4)		122(60.4)	635(57.8)
吸烟状况[例(%)]											χ²=44.43	<0.001
否	4 083(66.3)		1 029(63.8)		2 091(64.5)		146(72.3)		817(74.3)
是	2 074(33.7)		585(36.2)		1 151(35.5)		56(27.7)		282(25.7)
饮酒状况[例(%)]											χ²=50.94	<0.001
否	3 936(63.9)		933(57.8)		2 088(64.4)		135(66.8)		780(71.0)
是	2 221(36.1)		681(42.2)		1 154(35.6)		67(33.2)		319(29.0)
高血压[例(%)]											χ²=1 889.99	<0.001
否	4 525(73.5)		1 412(87.5)		2 771(85.5)		48(23.8)		294(26.8)
是	1 632(26.5)		202(12.5)		471(14.5)		154(76.2)		805(73.2)
心脏病[例(%)]											χ²=1 426.44	<0.001
否	5 478(89.0)		1 583(98.1)		3 114(96.1)		142(70.3)		639(58.1)
是	675(11.0)		31(1.9)		128(3.9)		60(29.7)		456(41.5)
糖尿病[例(%)]											χ²=699.89	<0.001
否	5 760(93.6)		1 589(98.5)		3 168(97.7)		153(75.7)		850(77.3)
是	383(6.2)		25(1.5)		74(2.3)		47(23.3)		237(21.6)
脑卒中[例(%)]											χ²=312.72	<0.001
否	6 029(97.9)		1 607(99.6)		3 229(99.6)		190(94.1)		1 003(91.3)
是	126(2.0)		7(0.4)		13(0.4)		12(5.9)		94(8.6)
慢性肺部疾患[例(%)]											χ²=503.90	<0.001
否	5 610(91.1)		1 555(96.3)		3 074(94.8)		163(80.7)		818(74.4)
是	543(8.8)		59(3.7)		168(5.2)		39(19.3)		277(25.2)
恶性肿瘤[例(%)]											χ²=64.86	<0.001
否	6 089(98.9)		1 610(99.8)		3 223(99.4)		196(97.0)		1 060(96.5)
是	61(1.0)		4(0.2)		19(0.6)		5(2.5)		33(3.0)
关节炎/风湿病[例(%)]											χ²=1 024.91	<0.001
否	4 388(71.3)		1 398(86.6)		2 517(77.6)		78(38.6)		395(35.9)
是	1 769(28.7)		216(13.4)		725(22.4)		124(61.4)		704(64.1)
累积慢性病种数[例(%)]											χ²=6 291.62	<0.001
0种	2 714(44.1)		1 070(66.3)		1 644(50.7)		0(0)		0(0.8)
1种	2 142(34.8)		544(33.7)		1 598(49.3)		0(0)		0(0)
≥2种	1 301(21.1)		0(0.0)		0(0.0)		202(100.0)		1 099(100.0)
基线CES-D-10评分(分)	4.5±2.8		3.5±2.7		4.7±2.7		3.9±2.8		5.1±2.7		F=92.40	<0.001

健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	模型1		模型2		模型3
健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
自评良好-无共病(参照组)	4 265	514	12.05	1.00[参照]	-	1.00[参照]	-	1.00[参照]	-
自评不良-无共病	7 473	1 419	18.99	1.63(1.47~1.80)	<0.001	1.60(1.45~1.77)	<0.001	1.54(1.39~1.71)	<0.001
自评良好-伴共病	754	120	15.92	1.37(1.13~1.68)	0.002	1.32(1.08~1.61)	0.007	1.40(1.14~1.71)	0.001
自评不良-伴共病	3 400	792	23.29	2.08(1.86~2.33)	<0.001	2.01(1.79~2.25)	<0.001	2.11(1.88~2.36)	<0.001

健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	模型1		模型2		模型3
健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
自评良好-无共病(参照组)	4 265	514	12.05	1.00[参照]	-	1.00[参照]	-	1.00[参照]	-
自评不良-无共病	7 473	1 419	18.99	1.63(1.47~1.80)	<0.001	1.60(1.45~1.77)	<0.001	1.54(1.39~1.71)	<0.001
自评良好-伴共病	754	120	15.92	1.37(1.13~1.68)	0.002	1.32(1.08~1.61)	0.007	1.40(1.14~1.71)	0.001
自评不良-伴共病	3 400	792	23.29	2.08(1.86~2.33)	<0.001	2.01(1.79~2.25)	<0.001	2.11(1.88~2.36)	<0.001

亚组分类	分层水平	健康不一致表型	人-周期数	新发抑郁 (例)	发病率 (%)	HR(95%CI)	P值	交互P值
性别	男性	自评不良-无共病	3 200	731	22.84	1.41(1.16~1.71)	<0.001	0.506
		自评良好-伴共病	359	66	18.38	1.26(0.87~1.82)	0.215	0.222
		自评不良-伴共病	1 604	414	25.81	1.75(1.41~2.16)	<0.001	0.127
	女性	自评不良-无共病	4 273	688	16.10	1.52(1.26~1.85)	<0.001	0.506
		自评良好-伴共病	395	54	13.67	1.68(1.17~2.41)	0.005	0.222
		自评不良-伴共病	1 796	378	21.05	2.14(1.72~2.65)	<0.001	0.127
年龄	<65岁	自评不良-无共病	5 456	1 047	19.19	1.50(1.28~1.77)	<0.001	0.573
		自评良好-伴共病	454	78	17.18	1.52(1.09~2.11)	0.013	0.509
		自评不良-伴共病	2 206	511	23.16	1.92(1.60~2.32)	<0.001	0.758
	≥65岁	自评不良-无共病	2017	372	18.44	1.36(1.07~1.74)	0.014	0.573
		自评良好-伴共病	300	42	14.00	1.32(0.88~1.99)	0.186	0.509
		自评不良-伴共病	1 194	281	23.53	1.89(1.46~2.45)	<0.001	0.758
家庭人均年收入	低收入组	自评不良-无共病	1 622	353	21.76	1.35(1.09~1.67)	0.005	0.316
		自评良好-伴共病	148	27	18.24	1.23(0.79~1.90)	0.354	0.404
		自评不良-伴共病	719	205	28.51	1.88(1.49~2.38)	<0.001	0.910
	中高收入组	自评不良-无共病	3062	564	18.42	1.56(1.30~1.86)	<0.001	0.316
		自评良好-伴共病	350	53	15.14	1.54(1.12~2.12)	0.008	0.404
		自评不良-伴共病	1 562	338	21.64	1.94(1.60~2.37)	<0.001	0.910
受教育程度	初中及以下	自评不良-无共病	6558	1 291	19.69	1.42(1.23~1.63)	<0.001	0.093
		自评良好-伴共病	645	109	16.90	1.40(1.07~1.83)	0.013	0.458
		自评不良-伴共病	2 917	721	24.72	1.89(1.62~2.21)	<0.001	0.602
	高中及以上	自评不良-无共病	915	128	13.99	2.45(1.40~4.29)	0.002	0.093
		自评良好-伴共病	109	11	10.09	2.09(0.85~5.18)	0.109	0.458
		自评不良-伴共病	483	71	14.70	2.64(1.41~4.93)	0.002	0.602
与子女同住情况	未同住	自评不良-无共病	3132	567	18.10	1.40(1.15~1.70)	<0.001	0.458
		自评良好-伴共病	345	56	16.23	1.40(0.96~2.03)	0.078	0.943
		自评不良-伴共病	1 548	360	23.26	1.84(1.48~2.28)	<0.001	0.867
	同住	自评不良-无共病	4 180	812	19.43	1.52(1.26~1.84)	<0.001	0.458
		自评良好-伴共病	396	61	15.40	1.47(1.03~2.11)	0.034	0.943
		自评不良-伴共病	1 789	423	23.64	2.04(1.64~2.52)	<0.001	0.867