Four-year trajectories of depressive symptoms and subsequent risk of hip fracture: evidence from China Health and Retirement Longitudinal Study.

Abstract

This longitudinal study examined the association between depressive symptom trajectories and the risk of hip fracture using a nationally representative dataset. The findings suggested that a high-increasing trajectory was a significant risk factor for hip fracture in females. Depression has been associated with increased risk of hip fracture; however, no study has specifically examined how trajectories of depressive symptoms influence hip fracture incidence. This study aimed to investigate the association between long-term depressive symptom trajectories and the 5-year risk of hip fracture, and whether this association differs by gender. We analyzed data from 8942 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptom trajectories (2011-2015) were identified using group-based trajectory modeling. Cox proportional hazards models were used to examine the association between these trajectories and the risk of hip fracture over the subsequent 5 years. Three distinct depressive symptom trajectories were identified: low-stable, moderate-stable, and high-increasing. Compared to the low-stable group, females in the high-increasing trajectory had a significantly higher risk of hip fracture (HR = 2.37, 95% CI 1.29-4.35, P < 0.01), while no significant risk increase was observed for the moderate-stable group (HR = 1.05, 95% CI 0.63-1.73, P > 0.05). This association was not found among males. Sensitivity analyses supported these findings. A high-increasing depressive symptom trajectory was significantly associated with an increased risk of hip fracture, particularly among females. Prioritizing targeted interventions for individuals with this trajectory is essential to mitigate their risk.