Depression as a mediator between socioeconomic status and risk of All-Cause and cardiovascular mortality in diabetes and prediabetes

Abstract

There is a known association between socioeconomic status (SES) and increased mortality risk in individuals with diabetes and its pre-diabetic state. Depression has been identified as a significant risk factor for mortality in populations with low SES. this study aims to gain a deeper Understanding of the relationship between SES and all-cause and cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state by exploring the mediating role of depression. This study included 17,823 participants who participated in the National health and nutrition examination survey (NHANES) between 2005 and 2018. Weighted multivariate COX regression analysis was conducted to evaluate the association between SES and all-cause and cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state. Additionally, mediation analysis was performed to explore the mediating role of depression. After adjusting for multiple variables, low SES was associated with a hazard ratio (HR) of 1.71 (95% CI: 1.42–2.02; P < 0.0001) for all-cause mortality risk and an HR of 1.88 (95% CI: 1.35–2.63; P < 0.001) for cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state. Furthermore, after adjusting for multiple variables, depression was associated with an HR of 1.51 (95% CI: 1.28–1.79; P < 0.0001) for all-cause mortality risk and an HR of 1.64 (95% CI: 1.18–2.27; P = 0.003) for cardiovascular mortality risk. Mediation model results revealed that after complete adjustment, depression accounted for 10.34% of the mediating effect of the relationship between SES and all-cause mortality risk in individuals with diabetes and its pre-diabetic state, and 9.30% of the mediating effect of the relationship between SES and cardiovascular mortality risk. Identifying individuals with depression and providing appropriate treatment May lower the risk of all-cause and cardiovascular mortality associated with diabetes and its pre-diabetic state in the low SES population.