Associations between smoking, tobacco types, and depression in middle-aged and elderly Chinese individuals: a cross-sectional analysis from the CHARLS study.

Abstract

Background and objective: Depression is a major public health issue with a profound impact on quality of life and mortality. Tobacco smoke is a leading risk factor for various health conditions. However, the relationship between smoking, types of tobacco and depression remains underexplored, especially in middle-aged and elderly populations in China. This study mainly examines the associations between smoking status, types of tobacco products, and depression in middle-aged and elderly individuals in China.

Methods: Data were derived from all five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS) in a pooled cross-sectional design. A total of 34,215 observations from adults aged 45 years and older were analysed. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10), with a score of 10 or higher indicating elevated depressive symptoms. Smoking status was categorized into current smokers, ex-smokers, and non-smokers, and tobacco types included conventional cigarettes, self-rolled cigarettes, pipes, and others (cigars and hookahs). Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of smoking and tobacco type with depressive symptoms. Generalized estimating equations and mixed-effects models were used as sensitivity analyses to account for repeated observations from the same individuals.

Results: The prevalence of depressive symptoms (CES-D-10 ≥ 10) was 34.06%. Current smokers had an OR of 1.25 (95% CI: 1.15, 1.35; p < 0.001) and ex-smokers an OR of 1.15 (95% CI: 1.06, 1.25; p < 0.001) relative to non-smokers. Among tobacco types, self-rolled cigarette smokers (OR: 1.53; 95% CI: 1.35, 1.74; p < 0.001) and pipe smokers (OR: 1.56; 95% CI: 1.35, 1.81; p < 0.001) showed the strongest associations, followed by users of cigars and hookahs (OR: 1.39; 95% CI: 1.15, 1.68; p < 0.001) and conventional cigarettes (OR: 1.10; 95% CI: 1.02, 1.19; p = 0.010).

Conclusions: In this middle-aged and elderly Chinese population, smoking and all examined tobacco types were associated with a higher prevalence of depressive symptoms, with the strongest associations observed for self-rolled and pipe tobacco. Because the design is cross-sectional, these findings indicate associations rather than causal effects, and underscore the need to integrate mental-health considerations into tobacco-control efforts, including attention to traditional and non-cigarette tobacco products.

Clinical trial number: Not applicable.