Urban–Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies

  • Jonathan Purtle
    Address correspondence to: Jonathan Purtle, DrPH, MPH, MSc, Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia PA 19104.
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Katherine L. Nelson
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Yong Yang
    Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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  • Brent Langellier
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Ivana Stankov
    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Ana V. Diez Roux
    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Published:February 16, 2019DOI:


      Depression among older adults (aged 60 years or older) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies.

      Evidence acquisition

      In 2017, the authors identified and extracted information from comparative studies of urban–rural depression prevalence among older adults. Studies were identified in PubMed, PsychINFO, and Web of Science and limited to English language articles published after 1985. Eighteen studies met inclusion criteria. Random effects meta-analysis was conducted to produce weighted pooled ORs estimating the association between urban–rural residence and depression for all study participants (N=31,598) and sub-analyses were conducted for developed (n=12,728) and developing (n=18,870) countries.

      Evidence synthesis

      Depression prevalence was significantly higher among urban residents in ten studies and significantly higher among rural residents in three studies (all three conducted in China). Associations between urban–rural residence and depression generally remained significant after adjusting for covariates. In developed countries, the odds of depression were significantly higher among urban than rural residents (pooled OR=1.44, 95% CI=1.10, 1.88). However, in developing countries, this association was not observed (pooled OR=0.91, 95% CI=0.46, 1.77).


      Converging trends of urbanization and population aging could increase the global burden of depression among older adults. The pathways through which urban–rural residence influences depression risk among older adults might differ by country context. Future research should focus on measuring variation in these contexts.
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