Longitudinal trajectories of somatic and cognitive-affective depressive symptoms influence stroke risk across different populations: Three prospective cohort studies

Table 1 Changes in depressive symptoms during the four waves of follow-up in three prospective cohort studies

Type	CES-D score	CHARLS				ELSA				HRS
		Wave 1	Wave 2	Wave 3	Wave 4	Wave 3	Wave 4	Wave 5	Wave 6	Wave 4	Wave 5	Wave 6	Wave 7
Depressive_symptom_trajectory	0	1431	1586	1616	1183	2537	2797	2479	2774	30	27	18	20
Depressive_symptom_trajectory	1	1696	2024	1697	1301	1419	1273	1346	1213	199	206	143	194
Depressive_symptom_trajectory	2	1552	1606	1290	994	597	502	655	578	5437	5493	5813	5865
Depressive_symptom_trajectory	3	1448	1273	1074	890	367	356	407	404	3112	3030	2765	2698
Depressive_symptom_trajectory	4	1529	1172	1035	922	227	250	242	244	1632	1567	1529	1519
Depressive_symptom_trajectory	5	1469	1009	866	927	169	194	177	163	965	997	986	964
Depressive_symptom_trajectory	6	1061	738	704	837	131	133	155	109	578	572	634	608
Depressive_symptom_trajectory	7	826	495	552	716	120	92	106	93	241	276	280	283
Depressive_symptom_trajectory	8	249	193	221	220	75	45	75	64	66	92	92	109
Somatic_trajectory	0	3295	3590	3213	2314	2894	3257	2855	3160	6230	6444	6774	6839
Somatic_trajectory	1	3562	3337	2967	2448	1685	1426	1612	1436	3566	3454	3010	2975
Somatic_trajectory	2	2941	2263	1894	1949	600	549	689	605	1676	1551	1570	1537
Somatic_trajectory	3	1463	906	981	1279	460	402	479	433	788	811	906	909
Cognitive_affective_trajectory	0	2329	2557	2521	1969	34	28	38	54	91	63	57	73
Cognitive_affective_trajectory	1	2233	2537	1953	1517	161	176	165	180	434	439	352	393
Cognitive_affective_trajectory	2	2099	1836	1533	1257	4240	4229	4163	4267	8778	8593	8673	8651
Cognitive_affective_trajectory	3	2374	1608	1500	1509	815	825	855	786	1901	1956	1973	1929
Cognitive_affective_trajectory	4	1771	1179	1132	1355	307	290	313	257	810	892	900	913
Cognitive_affective_trajectory	5	455	379	416	383	66	65	77	61	246	317	305	301

The China Health and Retirement Longitudinal Study cohort we used wave 1 as the baseline for the cohort with 4 waves of follow-up (follow-up to wave 4); the English Longitudinal Study of Ageing cohort used wave 3 as the baseline for the cohort with 4 waves of follow-up (follow-up to wave 6); and the Health and Retirement Study cohort used Wave 4 as the baseline for the cohort with 4 waves of follow-up (follow-up to wave 7). CES-D: Center for Epidemiological Studies Depression; CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study.

Table 2 Depressive symptom trajectory information determined from the four waves of follow-up data in three prospective cohort studies

Type	Term	CHARLS	ELSA	HRS
Overall		7990	5642	12260
Depressive_symptom_trajectory	Consistently low	1324	3394	2405
Depressive_symptom_trajectory	Consistently high	1649	260	7037
Depressive_symptom_trajectory	Decreasing	321	100	36
Depressive_symptom_trajectory	Fluctuating	4361	1751	2688
Depressive_symptom_trajectory	Increasing	335	137	94
Somatic_trajectory	Consistently low	2600	3418	548
Somatic_trajectory	Consistently high	705	251	7180
Somatic_trajectory	Decreasing	0	47	106
Somatic_trajectory	Fluctuating	4685	1838	4256
Somatic_trajectory	Increasing	0	88	167
Cognitive_affective_trajectory	Consistently low	1634	3001	10595
Cognitive_affective_trajectory	Consistently high	1144	2177	13
Cognitive_affective_trajectory	Decreasing	238	93	217
Cognitive_affective_trajectory	Fluctuating	4734	340	1422
Cognitive_affective_trajectory	Increasing	240	31	13

CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study.

Table 3 Hazard ratios between trajectories of total depressive symptoms and the risk of stroke occurrence

Type	Term	Source	Model	HR	Lower_CI	Upper_CI	SE	Beta	P value
Depressive_symptom_trajectory	Consistently low	Reference
Depressive_symptom_trajectory	Consistently high	CHARLS	1	2.06	1.57	2.71	0.14	5.19	2.08E-07
Depressive_symptom_trajectory	Consistently high	CHARLS	2	2.22	1.68	2.93	0.14	5.61	2.01E-08
Depressive_symptom_trajectory	Consistently high	CHARLS	3	1.80	1.36	2.38	0.14	4.08	4.60E-05
Depressive_symptom_trajectory	Decreasing	CHARLS	1	1.27	0.79	2.05	0.24	0.98	3.27E-01
Depressive_symptom_trajectory	Decreasing	CHARLS	2	1.33	0.82	2.15	0.24	1.17	2.44E-01
Depressive_symptom_trajectory	Decreasing	CHARLS	3	1.12	0.69	1.81	0.25	0.46	6.46E-01
Depressive_symptom_trajectory	Fluctuating	CHARLS	1	1.54	1.20	1.98	0.13	3.34	8.25E-04
Depressive_symptom_trajectory	Fluctuating	CHARLS	2	1.60	1.24	2.06	0.13	3.62	2.95E-04
Depressive_symptom_trajectory	Fluctuating	CHARLS	3	1.47	1.14	1.90	0.13	2.95	3.21E-03
Depressive_symptom_trajectory	Increasing	CHARLS	1	1.39	0.88	2.19	0.23	1.41	1.58E-01
Depressive_symptom_trajectory	Increasing	CHARLS	2	1.43	0.91	2.26	0.23	1.55	1.21E-01
Depressive_symptom_trajectory	Increasing	CHARLS	3	1.26	0.80	1.99	0.23	0.99	3.20E-01
Depressive_symptom_trajectory	Consistently low	Reference
Depressive_symptom_trajectory	Consistently high	ELSA	1	1.96	1.35	2.86	0.19	3.51	4.40E-04
Depressive_symptom_trajectory	Consistently high	ELSA	2	1.70	1.16	2.49	0.20	2.70	7.03E-03
Depressive_symptom_trajectory	Consistently high	ELSA	3	1.50	1.02	2.21	0.20	2.05	4.09E-02
Depressive_symptom_trajectory	Decreasing	ELSA	1	1.26	0.62	2.55	0.36	0.64	5.20E-01
Depressive_symptom_trajectory	Decreasing	ELSA	2	1.00	0.49	2.04	0.36	0.00	9.97E-01
Depressive_symptom_trajectory	Decreasing	ELSA	3	0.88	0.43	1.80	0.36	-0.35	7.25E-01
Depressive_symptom_trajectory	Fluctuating	ELSA	1	1.61	1.32	1.97	0.10	4.69	2.68E-06
Depressive_symptom_trajectory	Fluctuating	ELSA	2	1.51	1.23	1.85	0.10	3.91	9.31E-05
Depressive_symptom_trajectory	Fluctuating	ELSA	3	1.44	1.17	1.77	0.11	3.44	5.90E-04
Depressive_symptom_trajectory	Increasing	ELSA	1	2.28	1.42	3.64	0.24	3.44	5.91E-04
Depressive_symptom_trajectory	Increasing	ELSA	2	1.75	1.09	2.81	0.24	2.33	1.98E-02
Depressive_symptom_trajectory	Increasing	ELSA	3	1.71	1.06	2.74	0.24	2.22	2.63E-02
Depressive_symptom_trajectory	Consistently low	Reference
Depressive_symptom_trajectory	Consistently high	HRS	1	1.77	1.59	1.97	0.05	10.49	9.91E-26
Depressive_symptom_trajectory	Consistently high	HRS	2	1.66	1.49	1.86	0.06	8.92	4.82E-19
Depressive_symptom_trajectory	Consistently high	HRS	3	1.45	1.29	1.62	0.06	6.34	2.36E-10
Depressive_symptom_trajectory	Decreasing	HRS	1	0.86	0.32	2.29	0.50	-0.30	7.62E-01
Depressive_symptom_trajectory	Decreasing	HRS	2	0.75	0.28	2.00	0.50	-0.58	5.61E-01
Depressive_symptom_trajectory	Decreasing	HRS	3	0.67	0.25	1.80	0.50	-0.79	4.28E-01
Depressive_symptom_trajectory	Fluctuating	HRS	1	1.34	1.20	1.50	0.06	5.20	2.04E-07
Depressive_symptom_trajectory	Fluctuating	HRS	2	1.33	1.19	1.49	0.06	4.97	6.58E-07
Depressive_symptom_trajectory	Fluctuating	HRS	3	1.26	1.13	1.41	0.06	4.05	5.19E-05
Depressive_symptom_trajectory	Increasing	HRS	1	1.62	1.03	2.55	0.23	2.07	3.82E-02
Depressive_symptom_trajectory	Increasing	HRS	2	1.39	0.88	2.19	0.23	1.42	1.54E-01
Depressive_symptom_trajectory	Increasing	HRS	3	1.31	0.83	2.06	0.23	1.16	2.45E-01

Model 1 explores the unadjusted risk ratios of depressive symptom trajectories with stroke risk. Model 2 adjusts for age, gender, marital status, and education level in addition to the depressive symptom trajectories and stroke risk ratios. Model 3 further adjusts for smoking, alcohol consumption, hypertension, diabetes, and heart problems in addition to age, gender, marital status, education level, and the risk ratios of depressive symptom trajectories with stroke risk. CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; HR: Hazard ratio; CI: Confidence interval.

Table 4 Hazard ratios between trajectories of somatic depressive symptoms and the risk of stroke occurrence

Type	Term	Source	Model	HR	Lower_CI	Upper_CI	SE	Beta	P value
Somatic_trajectory	Consistently low	Reference
Somatic_trajectory	Consistently high	CHARLS	1	2.53	1.97	3.24	0.13	7.31	2.76E-13
Somatic_trajectory	Consistently high	CHARLS	2	2.65	2.05	3.42	0.13	7.50	6.62E-14
Somatic_trajectory	Consistently high	CHARLS	3	2.16	1.67	2.79	0.13	5.83	5.57E-09
Somatic_trajectory	Fluctuating	CHARLS	1	1.43	1.19	1.72	0.09	3.79	1.54E-04
Somatic_trajectory	Fluctuating	CHARLS	2	1.47	1.22	1.77	0.10	4.03	5.56E-05
Somatic_trajectory	Fluctuating	CHARLS	3	1.35	1.12	1.62	0.10	3.10	1.92E-03
Somatic_trajectory	Consistently low	Reference
Somatic_trajectory	Consistently high	ELSA	1	2.49	1.74	3.56	0.18	4.98	6.42E-07
Somatic_trajectory	Consistently high	ELSA	2	2.18	1.51	3.15	0.19	4.18	2.95E-05
Somatic_trajectory	Consistently high	ELSA	3	1.94	1.34	2.81	0.19	3.51	4.40E-04
Somatic_trajectory	Decreasing	ELSA	1	2.25	1.00	5.08	0.41	1.96	4.97E-02
Somatic_trajectory	Decreasing	ELSA	2	1.81	0.80	4.10	0.42	1.42	1.57E-01
Somatic_trajectory	Decreasing	ELSA	3	1.64	0.72	3.72	0.42	1.17	2.41E-01
Somatic_trajectory	Fluctuating	ELSA	1	1.84	1.51	2.25	0.10	6.07	1.31E-09
Somatic_trajectory	Fluctuating	ELSA	2	1.67	1.37	2.05	0.10	4.97	6.79E-07
Somatic_trajectory	Fluctuating	ELSA	3	1.56	1.27	1.92	0.10	4.26	2.08E-05
Somatic_trajectory	Increasing	ELSA	1	2.60	1.49	4.56	0.29	3.34	8.29E-04
Somatic_trajectory	Increasing	ELSA	2	2.02	1.15	3.54	0.29	2.44	1.47E-02
Somatic_trajectory	Increasing	ELSA	3	1.95	1.11	3.43	0.29	2.33	2.00E-02
Somatic_trajectory	Consistently low	Reference
Somatic_trajectory	Consistently high	HRS	1	2.25	1.89	2.68	0.09	9.09	9.78E-20
Somatic_trajectory	Consistently high	HRS	2	2.22	1.85	2.66	0.09	8.69	3.56E-18
Somatic_trajectory	Consistently high	HRS	3	1.79	1.49	2.15	0.09	6.22	4.84E-10
Somatic_trajectory	Decreasing	HRS	1	1.44	0.92	2.27	0.23	1.58	1.13E-01
Somatic_trajectory	Decreasing	HRS	2	1.46	0.93	2.30	0.23	1.63	1.03E-01
Somatic_trajectory	Decreasing	HRS	3	1.27	0.80	2.00	0.23	1.02	3.06E-01
Somatic_trajectory	Fluctuating	HRS	1	1.54	1.40	1.69	0.05	8.99	2.37E-19
Somatic_trajectory	Fluctuating	HRS	2	1.48	1.34	1.63	0.05	8.02	1.04E-15
Somatic_trajectory	Fluctuating	HRS	3	1.33	1.20	1.46	0.05	5.64	1.69E-08
Somatic_trajectory	Increasing	HRS	1	1.26	0.86	1.85	0.20	1.19	2.36E-01
Somatic_trajectory	Increasing	HRS	2	1.15	0.79	1.69	0.20	0.72	4.69E-01
Somatic_trajectory	Increasing	HRS	3	1.02	0.70	1.50	0.20	0.12	9.05E-01

Model 1 explores the unadjusted risk ratios of depressive symptom trajectories with stroke risk. Model 2 adjusts for age, gender, marital status, and education level in addition to the depressive symptom trajectories and stroke risk ratios. Model 3 further adjusts for smoking, alcohol consumption, hypertension, diabetes, and heart problems in addition to age, gender, marital status, education level, and the risk ratios of depressive symptom trajectories with stroke risk. CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; HR: Hazard ratio; CI: Confidence interval.

Table 5 Hazard ratios between trajectories of cognitive depressive symptoms and the risk of stroke occurrence

Type	Term	Source	Model	HR	Lower_CI	Upper_CI	SE	Beta	P value
Cognitive_affective_trajectory	Consistently low	Reference
Cognitive_affective_trajectory	Consistently high	CHARLS	1	2.31	1.71	3.11	0.15	5.46	4.82E-08
Cognitive_affective_trajectory	Consistently high	CHARLS	2	2.53	1.87	3.43	0.16	5.98	2.23E-09
Cognitive_affective_trajectory	Consistently high	CHARLS	3	2.06	1.52	2.81	0.16	4.63	3.73E-06
Cognitive_affective_trajectory	Decreasing	CHARLS	1	1.39	0.80	2.42	0.28	1.16	2.47E-01
Cognitive_affective_trajectory	Decreasing	CHARLS	2	1.45	0.83	2.54	0.28	1.32	1.87E-01
Cognitive_affective_trajectory	Decreasing	CHARLS	3	1.26	0.72	2.20	0.28	0.81	4.16E-01
Cognitive_affective_trajectory	Fluctuating	CHARLS	1	1.70	1.29	2.25	0.14	3.73	1.95E-04
Cognitive_affective_trajectory	Fluctuating	CHARLS	2	1.76	1.33	2.33	0.14	3.95	7.83E-05
Cognitive_affective_trajectory	Fluctuating	CHARLS	3	1.63	1.23	2.16	0.14	3.38	7.22E-04
Cognitive_affective_trajectory	Increasing	CHARLS	1	1.74	1.04	2.89	0.26	2.12	3.41E-02
Cognitive_affective_trajectory	Increasing	CHARLS	2	1.84	1.10	3.07	0.26	2.34	1.94E-02
Cognitive_affective_trajectory	Increasing	CHARLS	3	1.53	0.92	2.55	0.26	1.62	1.05E-01
Cognitive_affective_trajectory	Consistently low	Reference
Cognitive_affective_trajectory	Consistently high	ELSA	1	1.44	1.18	1.75	0.10	3.62	2.95E-04
Cognitive_affective_trajectory	Consistently high	ELSA	2	1.28	1.05	1.57	0.10	2.40	1.63E-02
Cognitive_affective_trajectory	Consistently high	ELSA	3	1.25	1.02	1.54	0.10	2.16	3.07E-02
Cognitive_affective_trajectory	Decreasing	ELSA	1	1.67	0.89	3.15	0.32	1.58	1.13E-01
Cognitive_affective_trajectory	Decreasing	ELSA	2	1.51	0.80	2.86	0.33	1.27	2.06E-01
Cognitive_affective_trajectory	Decreasing	ELSA	3	1.47	0.77	2.78	0.33	1.17	2.41E-01
Cognitive_affective_trajectory	Fluctuating	ELSA	1	1.76	1.24	2.49	0.18	3.18	1.48E-03
Cognitive_affective_trajectory	Fluctuating	ELSA	2	1.63	1.15	2.32	0.18	2.72	6.60E-03
Cognitive_affective_trajectory	Fluctuating	ELSA	3	1.58	1.11	2.24	0.18	2.52	1.16E-02
Cognitive_affective_trajectory	Increasing	ELSA	1	1.53	0.49	4.80	0.58	0.74	4.62E-01
Cognitive_affective_trajectory	Increasing	ELSA	2	1.49	0.48	4.68	0.58	0.69	4.93E-01
Cognitive_affective_trajectory	Increasing	ELSA	3	1.43	0.46	4.49	0.58	0.61	5.40E-01
Cognitive_affective_trajectory	Consistently low	Reference
Cognitive_affective_trajectory	Consistently high	HRS	1	2.15	0.30	15.29	1.00	0.77	4.44E-01
Cognitive_affective_trajectory	Consistently high	HRS	2	2.20	0.31	15.71	1.00	0.79	4.30E-01
Cognitive_affective_trajectory	Consistently high	HRS	3	2.04	0.29	14.55	1.00	0.71	4.76E-01
Cognitive_affective_trajectory	Decreasing	HRS	1	2.89	0.40	21.00	1.01	1.05	2.93E-01
Cognitive_affective_trajectory	Decreasing	HRS	2	2.82	0.39	20.51	1.01	1.02	3.07E-01
Cognitive_affective_trajectory	Decreasing	HRS	3	2.54	0.35	18.50	1.01	0.92	3.57E-01
Cognitive_affective_trajectory	Fluctuating	HRS	1	2.53	0.36	18.05	1.00	0.93	3.54E-01
Cognitive_affective_trajectory	Fluctuating	HRS	2	2.77	0.39	19.81	1.00	1.02	3.10E-01
Cognitive_affective_trajectory	Fluctuating	HRS	3	2.56	0.36	18.28	1.00	0.94	3.49E-01
Cognitive_affective_trajectory	Increasing	HRS	1	16.76	2.15	130.96	1.05	2.69	7.19E-03
Cognitive_affective_trajectory	Increasing	HRS	2	15.92	2.03	124.70	1.05	2.63	8.42E-03
Cognitive_affective_trajectory	Increasing	HRS	3	14.67	1.87	114.91	1.05	2.56	1.05E-02

Model 1 explores the unadjusted risk ratios of depressive symptom trajectories with stroke risk. Model 2 adjusts for age, gender, marital status, and education level in addition to the depressive symptom trajectories and stroke risk ratios. Model 3 further adjusts for smoking, alcohol consumption, hypertension, diabetes, and heart problems in addition to age, gender, marital status, education level, and the risk ratios of depressive symptom trajectories with stroke risk. CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; HR: Hazard ratio; CI: Confidence interval.