Association Between Systemic Immune-Inflammation Index and Diabetic Depression

Figures & data

Table 1 Characteristics of Participants in the NHANES (2009–2016) by Depression Status^a

	Diabetes Mellitus (n=2196)	Diabetic Depression^b (n=370)	p
Age (years)	61.8 ± 13.1	59.0 ± 12.8	<0.001
Male	1191 (54.2)	123 (33.2)	<0.001
Race (%)			<0.001
Mexican American	387 (18.1)	75 (20.7)
Other Hispanic	262 (12.2)	72 (19.8)
Non-Hispanic White	646 (30.1)	110 (30.3)
Non-Hispanic Black	609 (28.4)	92 (25.3)
Other	240 (11.2)	14 (3.9)
PIR	2.3 ± 1.5	1.4 ± 1.1	<0.001
Education (%)			0.135
Primary school	1003 (45.8)	188 (50.8)
High school	599 (27.4)	85 (23.0)
Above	586 (26.8)	97 (26.2)
Marital status			<0.001
Married/living with partner	1322 (60.5)	167 (45.1)
Widowed/divorced	669 (30.6)	155 (41.9)
Never married	195 (8.9)	48 (13.0)
BMI (kg/m^2)	32.2 ± 7.2	35.2 ± 9.2	<0.001
Smoking (%)			<0.001
Never smoker	1124 (51.5)	161 (43.5)
Former smoker	748 (34.2)	124 (33.5)
Current smoker	312 (14.3)	85 (23.0)
SII	546.2 ± 362.3	623.1 ± 393.6	<0.001
DM-related characteristics
HbA1c (%)	7.4 ± 1.8	7.6 ± 2.2	0.079
Diabetes duration (years)	10.9 ± 9.0	10.6 ± 8.8	0.783
Insulin use (%)			0.210
Yes	567 (25.9)	107 (29.0)
No	1623 (74.1)	262 (71.0)
Diabetic retinopathy (%)			0.206
Yes	491 (22.5)	93 (25.5)
No	1694 (77.5)	272 (74.5)
Chronic conditions heart failure (%)			<0.001
Yes	191 (8.8)	60 (16.3)
No	1986 (91.2)	308 (83.7)
Coronary heart disease (%)			0.087
Yes	226 (10.4)	49 (13.4)
No	1945 (89.6)	316 (86.6)
Stroke (%)			0.007
Yes	178 (8.1)	46 (12.5)
No	2009 (91.9)	323 (87.5)

Notes: ^aData are weighted estimates, and values are presented as means ± standard deviation or means (percentage). ^bDepressive symptom measured using Patient Health Questionnaire (PHQ‐9) and Depression (PHQ-9≥10).

Abbreviations: NHANES, National Health and Nutrition Examination Survey; PIR, poverty income ratio; BMI, body mass index; SII, systemic immune-inflammation index; DM, diabetes mellitus.

Table 2 Association Between SII and Diabetic Depression

SII	OR	95% CI	P
Model 1^a
<557.5	Reference
≥557.5	1.687	1.351–2.107	<0.00001
Model 2^b
<557.5	Reference
≥557.5	1.347	1.031–1.760	0.02882
Model 3^c
<557.5	Reference
≥557.5	1.452	1.104–1.908	0.00755

Notes: ^aModel 1 did not adjust for any confounding factors. ^bModel 2 adjusted for age, sex, race, education, marital status, body mass index, HbA1c, insulin use, poverty income ratio, smoking status, diabetes duration, chronic conditions including stroke (yes/no), CHD (yes/no), and HF (yes/no). ^cModel 3 after propensity score.

Abbreviations: SII, systemic immune-inflammation index; OR, odds ratio; CI, confidence interval.

Table 3 Characteristics of Patients Before and After PSM^a

	Before Propensity Score		After Propensity Score^c
	<557.5 (n=1395)	≥557.5 (n=1171)	< 557.5 (n=793)	≥557.5 (n=793)
Age (years)	64.1 ± 12.1	58.1± 13.5*	61.11 ± 12.20	60.68 ± 12.33
Male, n (%)	853 (61.1)	461 (39.4) *	404 (50.9)	387 (48.8)
Race, n (%)
Mexican American	253 (18.5)	209 (18.3)	142 (17.9)	140 (17.7)
Other Hispanic	170 (12.4)	164 (14.4)	95 (12)	122 (15.4)
Non-Hispanic White	435 (31.8)	321 (28.2)	251 (31.7)	241 (30.4)
Non-Hispanic Black	388 (28.0)	318 (27.9)	237 (29.9)	204 (25.7)
Other	126 (9.2)	128 (11.2)	68 (8.6)	86 (10.8)
PIR	2.2 ± 1.5	2.2 ± 1.5	2.2 ± 1.5	2.2 ± 1.5
Education, n (%)
Primary school	666 (47.9)	525 (45.0)	258 (32.5)	244 (30.8)
High school	379 (27.2)	305 (26.1)	197 (24.8)	231 (29.1)
Above	346 (24.9)	337 (28.9)	338 (42.6)	318 (40.1)
Marital status, n (%)		*
Married/partner	837 (60.2)	652 (56.0)	463 (58.4)	461 (58.1)
Widowed/divorced	445 (32.0)	379 (32.5)	255 (32.2)	254 (32)
Never married	109 (7.8)	337 (28.9)	75 (9.5)	78 (9.8)
BMI (kg/m^2)	31.9 ± 7.0	33.4 ± 8.0*	32.57 ± 7.49	33.08 ± 8.13
Smoking (%)
Never smoker	700 (50.3)	587 (50.3)	402 (50.7)	387 (48.8)
Former smoker	493 (35.4)	380 (32.6)	266 (33.5)	285 (35.9)
Current smoker	198 (14.2)	200 (17.1)	125 (15.8)	121 (15.3)
DM-related characteristics
Fasting Glucose (mg/dL)	157.7 ± 63.9	158.9± 65.6	160.4 ± 67.0	154.9 ± 61.3
HbA1c (%)	7.4 ± 1.8	7.6 ± 1.9*	7.5 ± 2.0	7.5 ± 1.8
Diabetes duration (years)	11.1 ± 9.1	10.5 ± 8.8	11.1 ± 9.2	10.9 ± 9.0
Insulin use, n (%)
Yes	322 (25.2)	352 (27.5)	206 (26)	182 (23)
No	956 (74.8)	929 (72.5)	585 (74)	609 (77)
DR, n (%)
Yes	318 (22.9)	266 (22.9)	175 (22.1)	175 (22.1)
No	1069(77.1)	897 (77.1)	618 (77.9)	618 (77.9)
HF, n (%)		*
Yes	168 (12.2)	83 (7.1)	62 (7.8)	62 (7.8)
No	1213 (87.8)	1081 (92.9)	731 (92.2)	731 (92.2)
CHD, n (%)		*
Yes	191 (13.9)	84 (7.2)	67 (8.4)	66 (8.3)
No	1184 (86.1)	1077 (92.8)	726 (91.6)	727 (91.7)
Stroke, n (%)
Yes	127 (9.1)	97 (8.3)	71 (9)	70 (8.8)
No	1264 (90.9)	1068 (91.7)	722 (91)	723 (91.2)
Depression^b, n (%)		*		*
Yes	160 (11.5)	210 (17.9)	105 (13.3)	144 (18.2)
No	1235 (88.5)	961 (82.1)	687 (86.7)	649 (81.8)
PHQ-9 scores	3.9 ± 4.9	4.8 ± 5.3*	4.2 ± 5.1	4.8 ± 5.4*

Notes: ^aData are presented as means ± standard deviation or means (percentage). ^bDepressive symptom measured using Patient Health Questionnaire (PHQ‐9) and Depression (PHQ-9≥10). ^c1:1 matching for age, sex, race, education, marital status, body mass index, HbA1c, insulin use, poverty income ratio, smoking status, diabetes duration, diabetic retinopathy, chronic conditions including stroke (yes/no), CHD (yes/no), and HF (yes/no). *p<0.05.

Abbreviations: PSM, propensity score matching; SII, systemic immune-inflammation index; BMI, body mass index; DM, diabetes mellitus; CHD, coronary heart disease; HF, heart failure; DR, diabetic retinopathy; PIR, ratio of family income to poverty.

Table 4 Subgroup Analysis of the Associations Between SII and Diabetic Depression

	N	OR (95% CI)	P
Age (years)
<60	968	1.683(1.190–2.380)	0.0032
≥60	1598	1.555 (1.155, 2.093)	0.0036
Sex
Male	1314	1.686 (1.162–2.447)	0.0059
Female	1252	1.077 (0.808–1.434)	0.6133
BMI^a
Normal weight	307	1.390 (0.653–2.958)	0.39311
Overweight	712	2.164 (1.289–3.632)	0.00349
Obese	1478	1.551 (1.185–2.030)	0.00138
HbA1c (%)
<7.0	1255	1.871 (1.363–2.567)	0.0001
≥7.0	1287	1.505 (1.097–2.066)	0.0113
Insulin use
No	1885	1.375 (1.057–1.788)	0.0176
Yes	674	1.822 (1.187–2.798)	0.0061

Note: ^aBMI was categorized as normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), or obese (≥30 kg/m²).

Abbreviations: SII, systemic immune-inflammation index; OR, odds ratio; CI, confidence interval; BMI, body mass index.

Table 5 Correlations Between SII vs Different Variables in All Subjects and Depressive Symptoms

	All Subjects		Without Depressive Symptoms^a		With Depressive Symptoms
	Pearson r^b	p	Pearson r	p	Pearson r	p
hs-CRP	0.3501	<0.0001	0.2981	<0.0001	0.6073	<0.0001
NLR	0.8403	<0.0001	0.8508	<0.0001	0.7968	<0.0001
PLR	0.7469	<0.0001	0.7515	<0.0001	0.7297	<0.0001

Notes: ^aDepressive symptom measured using Patient Health Questionnaire 9; Without Depressive Symptoms (PHQ-9<10), With Depressive Symptoms (PHQ-9≥10). ^bLinear regression was used for the analysis.

Abbreviations: SII, systemic immune-inflammation index; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; hs-CRP, high sensitive C-reactive protein.