Joint Association of Arterial Stiffness and Depression With New-Onset Self-Reported Chronic Obstructive Pulmonary Disease Among Elderly Chinese Population

Abstract

Background: Chronic Obstructive Pulmonary Diseases (COPD) impose a substantial global health burden, yet the joint impact of arterial stiffness and depression on their incidence remains underexplored. Methods: This cohort study analyzed adults aged ≥45 years from the China Health and Retirement Longitudinal Study (2011–2018). Participants with baseline COPD or missing data were excluded. Cox proportional hazards models assessed associations, while mediation analysis evaluated bidirectional roles of the estimated pulse wave velocity (ePWV) and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) in new-onset COPD. Results: Over 7 years, 718 participants developed COPD. ePWV (HR = 1.11, P < 0.0001) and depression (HR = 1.63, P < 0.0001) independently increased risk, with the highest hazard in comorbid cases (HR = 2.17, P < 0.0001). ePWV mediated 1.7% of depression's effect, while depression mediated 4.8% of ePWV's impact (P < 0.05). Conclusion: Higher ePWV and depressive symptoms were independently associated with incident chronic obstructive pulmonary disease. The observed mediation effects were statistically significant but small in magnitude and should be interpreted as exploratory rather than clinically meaningful. These findings are hypothesis-generating and warrant confirmation using objective measurements and causal study designs.