Joint trajectories of obesity and depressive symptoms and risk of incident glaucoma: a 16-year prospective cohort study from the Health and Retirement Study.

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.