Postgraduate medicine · 2025
Enhancing mortality prediction by incorporating depression into life's essential 8 in diabetic and prediabetic populations: evidence from NHANES 2009-2016.
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Shi Wenrui, Shi Yangbin, Park Jieun, Wu Shaohui
Аннотация
BACKGROUND: Life's Crucial 9 (LC9) was recently proposed by adding depression to Life's Essential 8 (LE8) to better predict future health risks. However, its superiority over LE8 in predicting outcomes in individuals with prediabetes or diabetes remains unclear.
METHODS: We analyzed data from 7044 individuals with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES). LC9 was calculated as the mean of the LE8 score and a depression score, representing psychological health. We used Cox regression to assess the association of these scores with all-cause and cardiovascular mortality. Receiver operating characteristic curves and reclassification analyses were employed to compare predictive performance.
RESULTS: During a median follow-up of 6.58 years (IQR: 4.67-8.75), 782 participants (11.10%) died, with 243 (3.45%) from cardiovascular causes. Each 10-point increase in LE8 score was associated with a hazard ratio (HR) of 0.807 (95% CI: 0.733-0.888) for all-cause mortality, while LC9 showed a stronger association with HR 0.750 (95% CI: 0.673-0.835). LC9 significantly improved the prediction of all-cause mortality (AUC 0.574 vs. 0.589, p = 0.021), supported by reclassification indices (p < 0.001). However, for cardiovascular mortality, both scores showed similar HRs, and no improvement was observed with LC9.
CONCLUSIONS: Incorporating depression into LE8 could improve the prediction of all-cause mortality in diabetic and prediabetic populations. Given its practicality and low cost, routine depression screening may offer a feasible strategy to enhance risk stratification in primary care settings.
METHODS: We analyzed data from 7044 individuals with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES). LC9 was calculated as the mean of the LE8 score and a depression score, representing psychological health. We used Cox regression to assess the association of these scores with all-cause and cardiovascular mortality. Receiver operating characteristic curves and reclassification analyses were employed to compare predictive performance.
RESULTS: During a median follow-up of 6.58 years (IQR: 4.67-8.75), 782 participants (11.10%) died, with 243 (3.45%) from cardiovascular causes. Each 10-point increase in LE8 score was associated with a hazard ratio (HR) of 0.807 (95% CI: 0.733-0.888) for all-cause mortality, while LC9 showed a stronger association with HR 0.750 (95% CI: 0.673-0.835). LC9 significantly improved the prediction of all-cause mortality (AUC 0.574 vs. 0.589, p = 0.021), supported by reclassification indices (p < 0.001). However, for cardiovascular mortality, both scores showed similar HRs, and no improvement was observed with LC9.
CONCLUSIONS: Incorporating depression into LE8 could improve the prediction of all-cause mortality in diabetic and prediabetic populations. Given its practicality and low cost, routine depression screening may offer a feasible strategy to enhance risk stratification in primary care settings.