Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study

Background: Hypertension is the most prevalent chronic disease among China's older population, which comprises agrowing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developingdepressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hyperten-sion exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptomsamong older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health LongevitySurvey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptomsbetween urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. Theproportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In ruralareas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; >= 7 years: OR 0.47, 95% CI 0.24-0.94), alcoholconsumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours:OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; >= 10.0 hours: OR 0.22, 95% CI 0.11-0.41) wereprotective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction(mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years:OR 0.37, 95% CI 0.16-0.81; >= 100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleepduration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; >= 10.0 hours: OR 0.18, 95%CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported incomestatus (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95%CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could beexplained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%),exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities(contribution -22.9%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residingin urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration,self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption