Joint trajectories of obesity and depressive symptoms and risk of incident glaucoma: a 16-year prospective cohort study from the Health and Retirement Study
Abstract
Background Obesity and depression frequently co-occur in older adults and share pathways potentially relevant to glaucoma, yet their dynamic co-evolution and joint contribution to glaucoma risk remain poorly characterized. Objectives This study aimed to identify joint longitudinal trajectories of body mass index (BMI) and depressive symptoms and evaluate their association with incident glaucoma. Methods Among 6,154 participants from the Health and Retirement Study (2000–2016) in the United States, we applied group-based multi-trajectory modeling to jointly classify BMI and CESD-8 trajectories over nine waves. Incident glaucoma was self-reported. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results Over a median follow-up of 12.0 years (interquartile range 8.0–16.0), 234 participants (3.8%) developed incident glaucoma. Four distinct joint trajectories were identified: Normal weight–Low Depression (23.5%, reference), Overweight–Low Depression (25.3%), Normal weight–High Depression (31.9%), and Obese–Moderate Depression (19.3%). Crude incidence rates per 1,000 person-years ranged from 1.92 (95% CI 1.31–2.71) in the reference group to 4.82 (95% CI 3.75–6.11) in the obese–moderate depression group (log-rank p < 0.001). In the fully adjusted model, compared with the reference trajectory, participants in the Overweight–Low Depression (HR 1.61, 95% CI 1.04–2.49), Normal weight–High Depression (HR 1.82, 95% CI 1.19–2.78), and obese–moderate depression (HR 2.52, 95% CI 1.61–3.93) groups had significantly increased glaucoma risk (p for trend < 0.001). These associations remained consistent across subgroups and sensitivity analyses. Conclusion Adverse joint trajectories of elevated BMI and depressive symptoms are independently and dose-dependently associated with higher glaucoma risk, supporting integrated monitoring of metabolic and psychological health in glaucoma prevention.