ArticleEuropean archives of psychiatry and clinical neuroscience2026
Association of the red blood cell distribution width-to-albumin ratio with incident depression and depressive symptom trajectories in older adults.
Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe ratio of red blood cell distribution width to albumin (RAR) is a systemic blood-based marker associated with adverse health outcomes. Although cross-sectional studies have suggested a link between RAR and depression, its longitudinal association with the incidence and long-term course of late-life depression has not yet been established. We aimed to address this knowledge gap using data from a large cohort of older adults.
methodsThis longitudinal cohort study used data from the Health and Retirement Study (2016-2022). The analysis of incident depression included 6,151 U.S. adults aged ≥ 60 years who were free of depression at baseline. Multivariable Cox regression was used to assess the association, and restricted cubic splines were applied to examine the dose-response relationship. In a subcohort of 5,588 participants, group-based trajectory modeling was used to identify depressive symptom trajectories, and their association with baseline RAR was examined using multinomial logistic regression.
resultsDuring a median follow-up of 6 years, 1,287 participants developed incident depression. In the fully adjusted model, each 1-unit increase in baseline RAR was associated with a 19% higher risk of incident depression (HR = 1.19; 95% CI: 1.06-1.33). Compared with the lowest quartile, the highest RAR quartile was associated with a higher risk of incident depression (HR = 1.20; 95% CI: 1.01-1.42). The dose-response analysis indicated a linear relationship (P for non-linearity = 0.961). Four distinct symptom trajectories were identified: "Non-depressed" (28.11%), "Low-stable" (40.89%), "Moderate-progressive" (25.42%), and "High-progressive" (5.58%). Compared with the "Non-depressed" group, higher baseline RAR was associated with greater odds of membership in the "High-progressive" (OR = 1.31; 95% CI: 1.11-1.55) and "Moderate-progressive" (OR = 1.36; 95% CI: 1.07-1.73) groups.
conclusionIn this large, nationally representative cohort of older adults, higher baseline RAR was longitudinally associated with an increased risk of incident depression and a subsequent long-term trajectory of worsening depressive symptoms.
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