Gastrointestinal Diseases and Persistent Depressive Trajectories in Older Adults Across Four International Aging Cohorts
Fangli Wu, Ning Wang, Jiahui YangObjective
To examine associations between gastrointestinal and hepatic diseases (GIHD) and long-term depressive symptom trajectories in older adults across diverse cultural and healthcare settings.
Methods
Longitudinal data from four aging cohorts were harmonized: CHARLS (China), SHARE (Europe), HRS (United States), and KLOSA (South Korea), comprising 40,161 adults aged ≥60 years with 4-6 follow-up waves. Group-based trajectory modeling (GBTM) identified distinct depressive symptom trajectories. Multinomial logistic regression, adjusted for baseline depressive symptoms and covariates, estimated odds of trajectory membership. Random-effects meta-analysis with Hartung-Knapp correction pooled cohort-specific estimates. Inverse probability weighting (IPW) and E-values assessed robustness to confounding.
Results
Three trajectories were identified in all cohorts: Stable Low, Increasing Mild, and Stable High. After adjustment for baseline depressive symptoms, GIHD independently predicted Stable High trajectory membership (pooled OR = 1.73, 95% CI: 1.31-2.28; I
2
= 21.2%). Upper gastrointestinal disorders showed exceptional cross-cultural consistency (pooled OR = 1.80, 95% CI: 1.69-1.92; I
2
= 0%). Liver disease was significantly associated in CHARLS (OR = 2.64, 95% CI: 1.15-6.07) but not in KLOSA. Associations were consistent across sexes (
Conclusions
Chronic gastrointestinal conditions independently predict persistent severe depressive trajectories in older adults across four countries. The zero heterogeneity for upper gastrointestinal disorders suggests a gut-brain axis mechanism, supporting systematic depression screening in geriatric gastroenterology practice.