Association of anxiety, depressive symptoms, and inflammatory indices with cardiometabolic multimorbidity

Cardiometabolic multimorbidity (CMM) represents a major global public health challenge associated with increased mortality and reduced quality of life. While psychological distress (including anxiety and depression) and systemic inflammation have each been linked to individual cardiometabolic conditions, their combined associations with multimorbidity remain insufficiently understood. Previous literature suggests interrelationships between psychological symptoms and inflammation, but the temporal direction of these relationships cannot be examined in the present cross-sectional analysis. This cross-sectional study included 5903 community-dwelling adults in Tangshan, China. Demographic, lifestyle, and mental health data were collected via structured questionnaires; anxiety and depression were assessed using the GAD-7 and PHQ-9 scales. Five inflammatory indices (NLR, PLR, SII, LNR, NPR) were derived from routine blood tests, and CMM was defined as the coexistence of ≥2 cardiometabolic conditions. Statistical analyses included multivariable logistic regression, restricted cubic spline modelling, interaction analyses, and sensitivity analyses. The sample included 44.49% males and 55.51% females, with an overall CMM prevalence of 15.2%. Anxiety (OR = 1.15, 95% CI: 1.00-1.28) and depression (OR = 1.25, 95% CI: 1.03-1.53) were associated with higher odds of prevalent CMM. In the fully adjusted model, higher tertiles of NLR, PLR, SII, LNR, and NPR were associated with CMM. Additional exploratory component-based analyses showed that standardized natural log(1+x)-transformed neutrophil and platelet counts remained associated with CMM in mutually adjusted models, whereas lymphocyte count did not. Exploratory discrimination analyses showed limited single-marker performance for anxiety or depressive symptoms across CMM strata (AUC range, 0.488-0.574), and adding inflammatory ratios or blood-cell components to common clinical determinants produced only small AUC changes (Delta AUC range, 0.001-0.020). These findings suggest that anxiety symptoms, depressive symptoms, and blood-cell-derived inflammatory indices are associated with prevalent cardiometabolic multimorbidity. However, the exploratory discrimination analyses indicated limited incremental or stand-alone discriminatory performance; therefore, these indices should not be interpreted as diagnostic or screening tools. Because this study was cross-sectional and observational, causal and predictive interpretations are not warranted.