Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States

Abstract

Background: To describe and examine the distribution, disability, and treatment associated with comorbid cardiovascular disease and major depressive disorder (CVD/MDD) among middle-aged and older ethnic/racial groups in the United States.

Methods: Cross-sectional data from a national probability sample of household resident adults (18 years and older; N = 16,423) living in the 48 coterminous United States were analyzed. We defined comorbid CVD/MDD as the presence of CVD (e.g. diabetes, hypertension, heart disease, and stroke) among adults who met MDD criteria at or after age 50 years.

Results: Two-thirds of middle-aged and older American adults meeting criteria major depression at or after age 50 years also reported a diagnosis of comorbid CVD. Blacks were most likely to meet our comorbid CVD/MDD (74.4%) criteria. The disease burden of depression was also highest among Black respondents. Differences in treatment due to race/ethnicity and comorbidity were not statistically significant.

Conclusions: Our findings indicate that among middle-aged and older US adults meeting MDD criteria more than half would also report a comorbid CVD. Comorbid CVD/MDD rates varied between the considered ethnic/race groups. Functional impairment associated with comorbid CVD/MDD was higher than MDD alone; however, depression care rates did not differ remarkably. Among middle-aged and older adults meeting MDD criteria, comorbid CVD may be the rule rather than the exception.

Figure 1

Estimated average days impaired^a (adjusted for sex and age) by ethnic/race group and depression type^b,c among middle-aged and older adults (50 years and older) meeting major depression criteria. Results are from a negative binomial regression model using CPES data. ^aImpairment is calculated as average impairment days across five functional domains based on the World Health Organization Disability Assessment Scale (WHODAS-II) including self-reported number of days out of role in: (1) overall role impairment, (2) cognition, (3) mobility, (4) self-care, and (5) social impairment. ^bMeeting criteria for lifetime major based on World Mental Health Composite International Diagnostic Interviews, with a depressive episode occurring at age 50 years or older and no reported cerebrovascular diseases (including diabetes, hypertension, heart disease, or stroke). ^cMeeting criteria for a lifetime major depressive disorder with a depressive episode occurring at age 50 years or older, and self-reported medical diagnoses of one or more cerebrovascular disease.