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

Research output: Contribution to journalArticleAcademicpeer-review


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
Article number214241
Pages (from-to)442-449
Number of pages8
JournalJournal of Epidemiology and Community Health
Issue number5
Early online date2020
Publication statusPublished - 1 May 2021

Cite this