Association Between Depression or Anxiety and the Risk of Hepatitis B Flares: A Nationwide Population-Based Cohort Study

Figures & data

Figure 1  The flowchart of study sample selection.

Table 1 Baseline Characteristics of the Depression/Anxiety Cohort and the Control Cohort

Characteristics	With Depression/Anxiety (n = 12,992)	Without Depression/Anxiety (n = 51,968)	p value
Age (median), years	49.2	49.7	0.958
Age groups (years)			0.999
18–29	1010 (7.8)	4040 (7.8)
30–39	2425 (18.7)	9700 (18.7)
40–49	3169 (24.4)	12,676 (24.4)
50–59	2941 (22.6)	11,764 (22.6)
≥60	3447 (26.5)	13,788 (26.5)
Gender			0.999
Male	7625 (58.7)	30,500 (58.7)
Female	5367 (41.3)	21,468 (41.3)
Hypertension			<0.001
No	11,028 (84.9)	44,657 (86.0)
Yes	1964 (15.1)	7311 (14.1)
Diabetes mellitus			0.884
No	11,417 (87.9)	45,640 (87.8)
Yes	1575 (12.1)	6328 (12.2)
Congestive heart failure			0.038
No	12,839 (98.8)	51,461 (99.0)
Yes	153 (1.2)	507 (1.0)
Stroke			<0.001
No	11,933 (91.8)	50,992 (98.1)
Yes	1059 (8.2)	976 (1.9)
Chronic obstructive pulmonary disease			<0.001
No	12,366 (95.2)	50,539 (97.3)
Yes	626 (4.8)	1429 (2.7)
Chronic kidney disease			0.019
No	12,659 (97.4)	50,441 (97.1)
Yes	333 (2.6)	1527 (2.9)
Migraine			<0.001
No	12,959 (99.7)	51,917 (99.9)
Yes	33 (0.3)	51 (0.1)
Osteoporosis			0.212
No	12,961 (99.8)	51,868 (99.8)
Yes	31 (0.2)	100 (0.2)
Hyperlipidemia			<0.001
No	12,563 (96.7)	50,528 (97.2)
Yes	429 (3.3)	1440 (2.8)

Figure 2 Kaplan-Meier analysis of the cumulative risk of hepatitis B flares according to depression/anxiety status.

Table 2 Risk of Hepatitis B Flares According to Selected Patient Characteristics

Variable	Unadjusted		Adjusted
	HR (95% CI)	p value	HR (95% CI)	p value
Anxiety or depression	1.112 (1.077–1.148)	< 0.001	1.173 (1.033–1.277)	0.003
Male sex	0.976 (0.921–1.032)	0.084	0.941 (0.914–0.995)	0.060
Age group (years)
18–29	Reference		Reference
30–39	0.840 (0.785–0.900)	< 0.001	0.900 (0.841–0.964)	0.009
40–49	0.759 (0.710–0.812)	< 0.001	0.730 (0.515–0.809)	< 0.001
50–59	0.837 (0.789–0.899)	< 0.001	0.852 (0.793–0.915)	< 0.001
≥60	0.800 (0.747–0.857)	< 0.001	0.833 (0.750–0.862)	< 0.001
Hypertension	1.804 (1.775–1.835)	< 0.001	1.033 (0.993–1.074)	0.024
Diabetes mellitus	1.321 (1.188–1.455)	< 0.001	1.807 (1.772–1.843)	< 0.001
Congestive heart failure	1.081 (1.046–1.096)	0.001	1.555 (1.483–1.639)	< 0.001
Stroke	1.954 (1.468–2.564)	< 0.001	1.778 (1.380–2.424)	< 0.001
Chronic obstructive pulmonary disease	1.331 (1.271–1.494)	< 0.001	1.023 (0.949–1.102)	0.349
Chronic kidney disease	1.088 (1.018–1.262)	0.013	1.047 (0.600–1.300)	0.410
Migraine	1.192 (0.995–1.467)	0.041	1.005 (0.692–1.345)	0.883
Osteoporosis	0.846 (0.628–1.142)	0.310	0.701 (0.519–1.044)	0.074
Hyperlipidemia	0.762 (0.697–0.832)	< 0.001	0.982 (0.898–1.074)	0.902

Abbreviations: CI, confidence interval; HR, hazard ratio.

Table 3 Factors of HBV Flares Stratified by Variables Listed in the Table by Using Cox Regression

		Adjusted HR	HR (95% CI)	p value
Total		1.173	1.033–1.277	0.003
Gender	Male	1.138	1.002–1.239	0.035
	Female	1.224	1.077–1.332	0.001
Age group (yrs)	18–29	1.663	1.463–1.810	<0.001
	30–39	1.305	1.149–1.421	<0.001
	40–49	1.086	0.956–1.182	0.096
	50–59	1.108	0.975–1.206	0.059
	≧60	1.099	0.967–1.196	0.071
Hypertension	No	1.173	1.032–1.277	0.003
	Yes	1.160	1.021–1.263	0.006
Diabetes mellitus	No	1.173	1.032–1.276	0.004
	Yes	1.137	1.010–1.237	0.038
Congestive heart failure	No	1.171	1.030–1.274	0.009
	Yes	1.197	1.053–1.303	<0.001
Stroke	No	1.671	1.471–1.819	<0.001
	Yes	1.992	1.691–2.092	<0.001
Chronic obstructive pulmonary disease	No	1.168	1.028–1.271	0.007
	Yes	1.455	1.281–1.584	<0.001
Chronic kidney disease	No	1.167	1.027–1.270	0.007
	Yes	1.221	1.075–1.329	<0.001
Migraine	No	1.172	1.032–1.276	0.001
	Yes	1.593	1.402–1.734	<0.001
Osteoporosis	No	1.173	1.032–1.277	0.003
	Yes	1.047	0.921–1.140	0.286
Hyperlipidemia	No	1.174	1.034–1.279	0.002
	Yes	1.171	1.031–1.275	0.006

Abbreviations: CI, confidence interval; HR, hazard ratio.

Table 4 Influence of Demographic and Clinical Variables on the Risk of Hepatitis B Flares Determined by Cox Regression

		Adjusted HR	HR (95% CI)	p value
Total		1.173	1.033–1.277	0.003
Gender	Male	1.138	1.002–1.239	0.035
	Female	1.224	1.077–1.332	0.001
Age group (years)	18–29	1.663	1.463–1.810	<0.001
	30–39	1.305	1.149–1.421	<0.001
	40–49	1.086	0.956–1.182	0.096
	50–59	1.108	0.975–1.206	0.059
	≧60	1.099	0.967–1.196	0.071
Hypertension	No	1.173	1.032–1.277	0.003
	Yes	1.160	1.021–1.263	0.006
Diabetes mellitus	No	1.173	1.032–1.276	0.004
	Yes	1.137	1.010–1.237	0.038
Congestive heart failure	No	1.171	1.030–1.274	0.009
	Yes	1.197	1.053–1.303	<0.001
Stroke	No	1.671	1.471–1.819	<0.001
	Yes	1.992	1.691–2.092	<0.001
Chronic obstructive pulmonary disease	No	1.168	1.028–1.271	0.007
	Yes	1.455	1.281–1.584	<0.001
Chronic kidney disease	No	1.167	1.027–1.270	0.007
	Yes	1.221	1.075–1.329	<0.001
Migraine	No	1.172	1.032–1.276	0.001
	Yes	1.593	1.402–1.734	<0.001
Osteoporosis	No	1.173	1.032–1.277	0.003
	Yes	1.047	0.921–1.140	0.286
Hyperlipidemia	No	1.174	1.034–1.279	0.002
	Yes	1.171	1.031–1.275	0.006

Abbreviations: CI, confidence interval; HR, hazard ratio.