Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 7, 2023
Date Accepted: May 30, 2024
Decomposition Analysis of Depressive Symptom Differences among Older Adults with Hypertension between Urban and Rural Areas: A Cross-Sectional Study
ABSTRACT
Background:
Hypertension is the most prevalent chronic disease among the elderly in China, and the serious aging population trend in China also suggests that the population of Chinese people suffering from hypertension may be increasing in recent years. Due to the accumulation effect of health, chronic disease patients are more likely to develop depressive symptoms than healthy elderly individuals, a phenomenon that has been confirmed among elderly individuals in China, with hypertension patients in urban and rural areas had different rates of depression.
Objective:
This study aimed to investigate the primary factors influencing and contributing to the disparities in depressive symptoms among urban and rural elderly hypertensive patients in China.
Methods:
A cross-sectional study design was employed, and data were derived from the 8th Chinese Longitudinal Health Longevity Survey (CLHLS) conducted in 2018. The study covered 23 provinces in China, and a total of 5,210 elderly hypertensive patients who met the criteria were selected from the 8th CLHLS. The Fairlie model was applied to analyze the factors impacting and contributing to the disparities in depressive symptoms between urban and rural elderly with hypertension. To ensure the robustness of the Fairlie model, a multiple imputation method was employed to supplement the missing values of covariates.
Results:
The study observed that 12.84% of the participants exhibited depressive symptoms, with the proportion of depressive symptoms in rural areas (14.05%) being significantly higher than that in urban areas (10.70%). The Fairlie model results revealed that 91.61% of the difference in depressive symptoms could be explained by the included observational covariates. Specifically, years of education (63.07%), self-reported income status (13.24%), exercise (45.65%), sleep duration (20.77%), ADL dysfunction (-9.64%), and comorbidity (-22.94%) were statistically significant in explaining the observed differences.
Conclusions:
The study concludes that elderly hypertensive patients in rural areas had higher depressive symptoms than their urban counterparts. As a recommendation, the Chinese government should focus on enhancing rural health education, providing fitness equipment, and offering support to vulnerable groups with shorter sleep durations and difficult economic conditions.
Citation
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