Gender, marital and educational inequalities in mid- To late-life depressive symptoms: Cross-cohort variation and moderation by urbanicity degree

Milagros A. Ruiz*, Marielle A. Beenackers, Dany Doiron, Asli Gurer, Aliou Sarr, Nazmul Sohel, Erik J. Timmermans, Rita Wissa, Basile Chaix, Martijn Huisman, Steinar Krokstad, Ruzena Kubinova, Sofia Malyutina, Parminder Raina, Abdonas Tamosiunas, Frank J. Van Lenthe, Martin Bobak

*Corresponding author for this work

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Background Although ageing populations are increasingly residing in cities, it is unknown whether depression inequalities are moderated by urbanicity degree. We estimated gender, marital and educational inequalities in depressive symptoms among older European and Canadian adults, and examined whether higher levels of urbanicity, captured by population density, heightened these inequalities. Methods Harmonised cross-sectional data on 97 826 adults aged ≥50 years from eight cohorts were used. Prevalence ratios (PRs) were calculated for probable depression, depressed affect and depressive symptom severity by gender, marital status and education within each cohort, and combined using random-effects meta-analysis. Using a subsample of 73 123 adults from six cohorts with available data on population density, we tested moderating effects measured by the number of residents per square kilometre. Results The pooled PRs for probable depression by female gender, unmarried or non-cohabitating status and low education were 1.48 (95% CI 1.28 to 1.72), 1.44 (95% CI 1.29 to 1.61) and 1.29 (95% CI 1.18 to 1.41), respectively. PRs for depressed affect and high symptom severity were broadly similar. Except for one Dutch cohort with findings in an unexpected direction, there was no evidence that population density modified depressive symptom inequalities. Conclusions Despite cross-cohort variation in gender, marital status and educational inequalities in depressive symptoms, there was weak evidence that these inequalities differed by levels of population density.

Original languageEnglish
Pages (from-to)442-449
Number of pages8
JournalJournal of Epidemiology and Community Health
Issue number5
Publication statusPublished - 1 May 2021

Bibliographical note

Funding Information:
Funding This study is supported by a European Commission Horizon 2020 Grant, 667661, as part of the Promoting Mental Well-being in the Ageing Population: Determinants, Policies and Interventions in European Cities (MINDMAP) research project. This research was made possible using the data/ biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 94473 and the Canada Foundation for Innovation. This research has been conducted using the CLSA data set, Baseline Comprehensive Dataset version 4.0, under application number 171013. The CLSA is led by Drs Parminder Raina, Christina Wolfson and Susan Kirkland. The Nord-Trøndelag Health Study (HUNT) is mainly funded by the Norwegian Ministry of Health (NTNU), with additional support from the Norwegian Research Council (the FUGE programme), Central Norway Regional Health Authority, the Nord-Trøndelag County Council and the Norwegian Institute of Public Health. The Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study is funded by the Wellcome Trust (grants 064947 and 081081), the US National Institute on Aging (grant R01 AG23522-01), the MacArthur Foundation ‘MacArthur Initiative on Social Upheaval and Health’ (grant 712058). The Longitudinal Aging Study Amsterdam (LASA) is largely supported by grants from the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care. The Residential Environment and CORonary heart Disease (RECORD) study is supported by INPES (National Institute for Prevention and Health Education); IReSP (Institute for Public Health Research); InVS (National Institute of Public Health Surveillance); French Ministries of Research and Health; CNAM-TS (National Health Insurance Office for Salaried Workers); and the Ile-de-France Regional Health Agency (ARS). MAB’s work was funded by a Netherlands Organization for Scientific Research (NWO) VENI grant on ‘DenCityHealth: How to keep growing urban populations healthy?’ (grant 09150161810158).

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