Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020
BackgroundStroke is a significant health threat, and its complex interplay with fractures warrants further investigation. Depression, a critical psychological mediator in various health conditions, may also play a role. This study aims to clarify the intricate relationships among stroke, depressive...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1533565/full |
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| author | Yuqin Dan Xuewen Pei Danghan Xu Zhaoxi Liu Yuqi Wang Meng Yin Li Li Gongchang Yu Gongchang Yu |
| author_facet | Yuqin Dan Xuewen Pei Danghan Xu Zhaoxi Liu Yuqi Wang Meng Yin Li Li Gongchang Yu Gongchang Yu |
| author_sort | Yuqin Dan |
| collection | DOAJ |
| description | BackgroundStroke is a significant health threat, and its complex interplay with fractures warrants further investigation. Depression, a critical psychological mediator in various health conditions, may also play a role. This study aims to clarify the intricate relationships among stroke, depressive symptoms, and fracture risk, potentially informing more holistic clinical strategies.MethodsUtilizing the most recent data from the National Health and Nutrition Examination Survey (NHANES, 2017 to 2020), this study encompassed 4,979 valid samples. T-test and chi square test are conducted to compare the differences between fracture and non fracture subgroups. Subsequently, regression models were applied to assess the mediating impact of depression, with Sobel’s test and the bootstrap method deployed to substantiate the mediation pathways.ResultsIn this study, we conducted subgroup and regression analyses to investigate factors influencing fractures in stroke patients using NHANES data. Subgroup analysis revealed significant associations with gender, race, osteoporosis, and depression. Female stroke patients had a higher fracture rate (73.86% vs. 47.78%, p < 0.001), and those with post-stroke depression (29.67% vs. 13.16%, p < 0.001) or osteoporosis (33.33% vs. 15.81%, p < 0.05) were at increased risk of fractures. Logistic regression models showed a positive association between stroke and fractures in the unadjusted (OR = 1.862, 95% CI: 1.348–2.573, p < 0.001) and adjusted I models (OR = 1.789, 95% CI: 1.240–2.581, p < 0.01), but not in the adjusted II model. Depression was significantly correlated with fractures in all models (unadjusted OR = 2.785, 95% CI: 1.271–6.101, p < 0.05; Model 1 OR = 3.737, 95% CI: 1.470–9.498, p < 0.01; Model 2 OR = 3.068, 95% CI: 1.026–9.175, p < 0.05). Mediation analysis using Sobel and bootstrap tests indicated that depression mediates 7.657% of the relationship between stroke and fractures (Z = 2.31, p < 0.05), with significant indirect (Z = 2.80, p < 0.01), direct (Z = 3.61, p < 0.001), and total effects (Z = 3.92, p < 0.01). The direct effect of stroke on fracture was 0.079 (95% CI: 0.036–0.121), the total effect was 0.085 (95% CI: 0.043–0.128), and the indirect effect mediated by depressive symptoms was 0.007 (95% CI: 0.002–0.011). These results suggest that depressive symptoms following stroke may contribute to an increased risk of fractures.ConclusionDepressive symptoms serve as a critical mediator in the link between stroke and fracture risk. Consequently, our study concludes that holistic prevention strategies for fractures in stroke patients must incorporate a focus on mental health to effectively address this complex clinical challenge. |
| format | Article |
| id | doaj-art-50185e2388e042fd9fc755c614fde5e8 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Frontiers in Neurology |
| spelling | doaj-art-50185e2388e042fd9fc755c614fde5e82025-02-05T05:17:44ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-02-011610.3389/fneur.2025.15335651533565Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020Yuqin Dan0Xuewen Pei1Danghan Xu2Zhaoxi Liu3Yuqi Wang4Meng Yin5Li Li6Gongchang Yu7Gongchang Yu8Shandong University of Traditional Chinese Medicine, Rehabilitation Medicine School, Jinan, ChinaState University of New York at Buffalo, Albany, NY, United StatesThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Rehabilitation Center, Guangzhou, ChinaAffiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, ChinaShandong University of Traditional Chinese Medicine, Rehabilitation Medicine School, Jinan, ChinaNeck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, ChinaThe Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Rehabilitation Medicine Department, Jinan, ChinaNeck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, ChinaThe Central Laboratory, Shandong Mental Health Center, Shandong University, Jinan, ChinaBackgroundStroke is a significant health threat, and its complex interplay with fractures warrants further investigation. Depression, a critical psychological mediator in various health conditions, may also play a role. This study aims to clarify the intricate relationships among stroke, depressive symptoms, and fracture risk, potentially informing more holistic clinical strategies.MethodsUtilizing the most recent data from the National Health and Nutrition Examination Survey (NHANES, 2017 to 2020), this study encompassed 4,979 valid samples. T-test and chi square test are conducted to compare the differences between fracture and non fracture subgroups. Subsequently, regression models were applied to assess the mediating impact of depression, with Sobel’s test and the bootstrap method deployed to substantiate the mediation pathways.ResultsIn this study, we conducted subgroup and regression analyses to investigate factors influencing fractures in stroke patients using NHANES data. Subgroup analysis revealed significant associations with gender, race, osteoporosis, and depression. Female stroke patients had a higher fracture rate (73.86% vs. 47.78%, p < 0.001), and those with post-stroke depression (29.67% vs. 13.16%, p < 0.001) or osteoporosis (33.33% vs. 15.81%, p < 0.05) were at increased risk of fractures. Logistic regression models showed a positive association between stroke and fractures in the unadjusted (OR = 1.862, 95% CI: 1.348–2.573, p < 0.001) and adjusted I models (OR = 1.789, 95% CI: 1.240–2.581, p < 0.01), but not in the adjusted II model. Depression was significantly correlated with fractures in all models (unadjusted OR = 2.785, 95% CI: 1.271–6.101, p < 0.05; Model 1 OR = 3.737, 95% CI: 1.470–9.498, p < 0.01; Model 2 OR = 3.068, 95% CI: 1.026–9.175, p < 0.05). Mediation analysis using Sobel and bootstrap tests indicated that depression mediates 7.657% of the relationship between stroke and fractures (Z = 2.31, p < 0.05), with significant indirect (Z = 2.80, p < 0.01), direct (Z = 3.61, p < 0.001), and total effects (Z = 3.92, p < 0.01). The direct effect of stroke on fracture was 0.079 (95% CI: 0.036–0.121), the total effect was 0.085 (95% CI: 0.043–0.128), and the indirect effect mediated by depressive symptoms was 0.007 (95% CI: 0.002–0.011). These results suggest that depressive symptoms following stroke may contribute to an increased risk of fractures.ConclusionDepressive symptoms serve as a critical mediator in the link between stroke and fracture risk. Consequently, our study concludes that holistic prevention strategies for fractures in stroke patients must incorporate a focus on mental health to effectively address this complex clinical challenge.https://www.frontiersin.org/articles/10.3389/fneur.2025.1533565/fullstrokefracturedepressionassociationNHANESmediation |
| spellingShingle | Yuqin Dan Xuewen Pei Danghan Xu Zhaoxi Liu Yuqi Wang Meng Yin Li Li Gongchang Yu Gongchang Yu Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 Frontiers in Neurology stroke fracture depression association NHANES mediation |
| title | Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 |
| title_full | Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 |
| title_fullStr | Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 |
| title_full_unstemmed | Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 |
| title_short | Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020 |
| title_sort | association between stroke and fracture and the mediating role of depression a cross sectional study from nhanes 2017 to 2020 |
| topic | stroke fracture depression association NHANES mediation |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1533565/full |
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