Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education.

OBJECTIVES

To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.

METHODS

We identified the prevalence of depressive symptoms among US-born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.

RESULTS

In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12-1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99-1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87-1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural).

CONCLUSIONS

Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.