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The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.

Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, Vos T, Whiteford HA - BMC Med (2013)

Bottom Line: As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010.Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.The present work comprises the most robust systematic review of its kind to date.

View Article: PubMed Central - HTML - PubMed

Affiliation: Queensland Centre for Mental Health Research, Brisbane, Australia. fiona_charlson@qcmhr.uq.edu.au.

ABSTRACT

Background: Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.

Methods: A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.

Results: The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.

Conclusions: The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

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Global ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression by age and sex, 2010.
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Figure 2: Global ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression by age and sex, 2010.

Mentions: The overall age pattern shows a steady increase in attributable burden that peaks at around 60 years of age (Figure 2). The sharp rise in attributable DALYS in the older ages is reflective of the significant rise in IHD burden in this group [37]. As expected, males demonstrate higher burden of IHD attributable to major depression than females; however, this is only maintained until around age 80. Note the apparent sudden increase in DALYs after age 80 in females is an artifact of an 80+ age group (as opposed to a 5-year age group). The drop in burden seen at around 60 years of age for males is explained by a moderately high (and peak) IHD death rate in middle age coupled with large population at risk at those ages, despite a higher IHD death rate at older ages. Female IHD risk accelerates around age 65 years and explains the late rise in DALYs. It is important to note that uncertainty bounds around male and female estimates are large and overlapping.


The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.

Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, Vos T, Whiteford HA - BMC Med (2013)

Global ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression by age and sex, 2010.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222499&req=5

Figure 2: Global ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression by age and sex, 2010.
Mentions: The overall age pattern shows a steady increase in attributable burden that peaks at around 60 years of age (Figure 2). The sharp rise in attributable DALYS in the older ages is reflective of the significant rise in IHD burden in this group [37]. As expected, males demonstrate higher burden of IHD attributable to major depression than females; however, this is only maintained until around age 80. Note the apparent sudden increase in DALYs after age 80 in females is an artifact of an 80+ age group (as opposed to a 5-year age group). The drop in burden seen at around 60 years of age for males is explained by a moderately high (and peak) IHD death rate in middle age coupled with large population at risk at those ages, despite a higher IHD death rate at older ages. Female IHD risk accelerates around age 65 years and explains the late rise in DALYs. It is important to note that uncertainty bounds around male and female estimates are large and overlapping.

Bottom Line: As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010.Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.The present work comprises the most robust systematic review of its kind to date.

View Article: PubMed Central - HTML - PubMed

Affiliation: Queensland Centre for Mental Health Research, Brisbane, Australia. fiona_charlson@qcmhr.uq.edu.au.

ABSTRACT

Background: Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.

Methods: A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.

Results: The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.

Conclusions: The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

Show MeSH
Related in: MedlinePlus