Type 2 diabetes and chronic gastritis/duodenitis comorbidity: additive risk for incident depression and synergistic risk for all-cause mortality – a retrospective cohort study

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Abstract Background Type 2 diabetes (T2D) and chronic gastritis/duodenitis (CGD) are both associated with the onset of depression and mortality. However, the impact of T2D-CGD comorbidity on incident depression and mortality remains unclear. Method This retrospective cohort study utilized data from 387,149 participants in the UK Biobank to examine the relationship between T2D-CGD comorbidity, incident depression, and all-cause mortality. Outcome Patients with T2D are more likely to develop CGD compared to those without T2D (odds ratio = 2·10, 95% CI = [1·97, 2·24]). T2D, CGD, and their comorbidity each independently increased risks of depression incidence and all-cause mortality, with T2D-CGD showing the strongest associations for both (depression incidence: adjusted hazard ratio [aHR] = 2·29, 95% CI = [1·84, 2·85]; all-cause mortality: aHR = 2·57, 95% CI = [2·28, 2·88]). The synergistic effect of T2D and CGD on all-cause mortality was 1·92 times that of their individual effects combined (synergy index = 1·92, 95% CI = [1·56, 2·31]). The comorbidity was associated with a higher risk of depression and all-cause mortality within 15 years of disease onset. White matter hyperintensity, particularly near the cerebral ventricles, partially mediated the relationship between T2D-CGD comorbidity and incident depression. Interpretation Integrated screening and long-term monitoring strategies should be prioritized for population with the comorbidity of T2D and CGD, as it significantly elevates the risk of both incident depression and all-cause mortality.

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