Table 2.
Association of Concurrent Depressive Symptoms and Perceived Stress With Incident Total CVD, Acute Coronary Heart Disease, Cardiovascular Death, and All‐Cause Mortality Shown Separately for REGARDS Participants With High and Low Income
| Variable | Income ≥$35 000 | Income <$35 000 | ||||
|---|---|---|---|---|---|---|
| No Depressive Symptoms and No/Low Stress (n=9265) | Elevated Depressive Symptoms or Stress (n=2504) | Elevated Depressive Symptoms and Stress (n=430) | No Depressive Symptoms and No/Low Stress (n=6385) | Elevated Depressive Symptoms or Stress (n=2937) | Elevated Depressive Symptoms and Stress (n=1137) | |
| Total CVD (incident nonfatal MI, nonfatal stroke, or cardiovascular death) | ||||||
| Number of events | 524 | 144 | 14 | 636 | 312 | 123 |
| Age‐adjusted IR/1000 person‐years (95% CI) | 6.8 (6.1–7.5) | 7.9 (6.6–9.4) | 5.2 (3.0–9.2) | 13.4 (12.3–14.7) | 16.2 (14.3–18.3)a , d | 21.2 (17.6–25.7)c , d |
| Age‐adjusted HR (95% CI) | Ref | 1.16 (0.96–1.41) | 0.77 (0.43–1.37) | Ref | 1.20 (1.05–1.38)d | 1.53 (1.05–1.39)d |
| Model 1 HR (95% CI) | Ref | 1.24 (1.03–1.51)d | 0.90 (0.50–1.60) | Ref | 1.23 (1.07–1.42)d | 1.58 (1.29–1.93)d |
| Model 2 HR (95% CI) | Ref | 1.18 (0.97–1.42) | 0.85 (0.48–1.51) | Ref | 1.21 (1.05–1.39)d | 1.54 (1.26–1.88)d |
| Model 3 HR (95% CI) | Ref | 1.17 (0.97–1.42) | 0.78 (0.44–1.39) | Ref | 1.20 (1.04–1.38)d | 1.48 (1.21–1.81)d |
| Psychosocial risk and income interaction, P valuee | 0.11d | |||||
| Acute coronary heart disease | ||||||
| Number of events | 298 | 77 | 7 | 302 | 151 | 59 |
| Age‐adjusted IR/1000 person‐years (95% CI) | 4.0 (3.5–5.6) | 4.4 (3.5–5.6) | 2.6 (1.2–5.8) | 6.9 (6.1–7.8) | 8.3 (7.0–9.9) | 9.9 (7.6–13.0)a , d |
| Age‐adjusted HR (95% CI) | Ref | 1.08 (0.84–1.40) | 0.66 (0.30–1.46) | Ref | 1.20 (0.99–1.47) | 1.45 (1.09–1.93)d |
| Model 1 HR (95% CI) | Ref | 1.19 (0.91–1.54) | 0.80 (0.36–1.77) | Ref | 1.24 (1.02–1.52)d | 1.50 (1.12–1.99)d |
| Model 2 HR (95% CI) | Ref | 1.11 (0.86–1.43) | 0.74 (0.33–1.64) | Ref | 1.21 (1.00–1.48) | 1.44 (1.08–1.92)d |
| Model 3 HR (95% CI) | Ref | 1.10 (0.85–1.43) | 0.68 (0.31–1.52) | Ref | 1.21 (0.99–1.47) | 1.37 (1.03–1.83)d |
| Psychosocial risk and income interaction, P valuee | 0.33 | |||||
| Cardiovascular death | ||||||
| Number of events | 160 | 48 | 4 | 289 | 147 | 54 |
| Age‐adjusted IR/1000 person‐years (95% CI) | 1.7 (1.4–2.2) | 2.3 (1.7–3.2) | 1.2 (0.4–3.7) | 4.9 (4.2–5.6) | 6.2 (5.2–7.5)a , d | 7.4 (5.5–7.4)a , d |
| Age‐adjusted HR (95% CI) | Ref | 1.30 (0.94–1.81) | 0.78 (0.23–2.63) | Ref | 1.26 (1.03–1.54)d | 1.59 (1.18–2.14)d |
| Model 1 HR (95% CI) | Ref | 1.34 (0.96–1.87) | 0.87 (0.26–2.91) | Ref | 1.27 (1.04–1.56)d | 1.59 (1.18–2.15)d |
| Model 2 HR (95% CI) | Ref | 1.23 (0.88–1.72) | 0.77 (0.24–2.53) | Ref | 1.23 (1.002–1.50)d | 1.61 (1.19–2.17)d |
| Model 3 HR (95% CI) | Ref | 1.21 (0.86–1.69) | 0.71 (0.21–2.36) | Ref | 1.22 (0.99–1.49) | 1.54 (1.13–2.08)d |
| Psychosocial risk and income interaction, P valuee | 0.54 | |||||
| All‐cause mortality | ||||||
| Number of events | 618 | 183 | 27 | 1043 | 506 | 191 |
| Age‐adjusted IR/1000 person‐years (95% CI) | 6.4 (5.8–7.2) | 8.2 (7.0–9.7)a , d | 8.7 (5.8–13.1) | 19.2 (17.8–20.7) | 22.8 (20.6–25.3)b , d | 28.4 (24.3–33.3)c , d |
| Age‐adjusted HR (95% CI) | Ref | 1.31 (1.10–1.55)d | 1.47 (0.98–2.21) | Ref | 1.21 (1.09–1.35)d | 1.54 (1.32–1.80)d |
| Model 1 HR (95% CI) | Ref | 1.34 (1.13–1.59)d | 1.64 (1.09–2.48)d | Ref | 1.24 (1.12–1.39)d | 1.61 (1.37–1.88)d |
| Model 2 HR (95% CI) | Ref | 1.26 (1.06–1.50)d | 1.56 (1.03–2.26)d | Ref | 1.22 (1.09–1.36)d | 1.61 (1.37–1.89)d |
| Model 3 HR (95% CI) | Ref | 1.25 (1.05–1.48)d | 1.40 (0.92–2.12) | Ref | 1.21 (1.08–1.35)d | 1.55 (1.31–1.82)d |
| +SF‐12 PCS HR (95% CI) | Ref | 1.15 (0.96–1.37) | 1.27 (0.83–1.92) | Ref | 1.11 (0.99–1.24) | 1.33 (1.13–1.56)d |
| Psychosocial risk and income interaction, P valuee | 0.53 | |||||
IRs and HRs for the psychosocial risk groups. Model 1 adjusts for age, sex, race, geographic region, and number of people in the household. Model 2 adjusts for model 1 covariates plus systolic blood pressure, self‐reported antihypertensive medication use, total cholesterol, high‐density lipoprotein cholesterol, statin use, log‐transformed albumin:creatinine ratio, log‐transformed high‐sensitivity C‐reactive protein, estimated glomerular filtration rate, waist circumference, and diabetes mellitus. Model 3 adjusts for model 2 covariates plus cigarette smoking, alcohol use, physical activity, and medication adherence. The final model for all‐cause mortality adjusts for model 3 covariates plus the PCS of the SF‐12. Missing data in covariates were imputed using chain equations in 10 data sets with sample bootstrapping. CVD indicates cardiovascular disease; HR, hazard ratio; IR, incidence rate; MI, myocardial infarction; PCS, Physical Component Summary score; Ref, reference value; REGARDS, Reasons for Geographical and Racial Differences in Stroke; SF‐12, 12‐Item Short Form Health Survey.
Incidence rate is significantly different compared with the group with no depression and no stress, P<0.05.
Incidence rate is significantly different compared with the group with no depression and no stress, P≤0.01.
Incidence rate is significantly different compared with the group with no depression and no stress, P≤0.001.
Significant at P<0.05.
Interaction term P value from the overall (not stratified) final model.