RACIAL AND ETHNIC DISPARITIES IN DEPRESSION SEVERITY, SYMPTOM BURDEN AND CARE AMONG OLDER ADULTS

Abstract

Introduction IMPORTANCE: Knowledge gaps persist regarding racial and ethnic variation in late-life depression (LLD), including differences in specific depressive symptoms and disparities in care. Identifying disparities in symptom presentation and treatment of LLD is important, as doing so may guide approaches to reduce morbidity and mortality from LLD. Thus, we aimed to evaluate racial/ethnic differences in depression severity, item-level depressive symptom burden, and depression care. Methods DESIGN, SETTING, PARTICIPANTS: In this community based large cross-sectional study, we included 25,503 participants (mean age=67.1 years) in the late-life depression prevention ancillary study (VITAL-DEP) to the VITamin D and OmegA-3 TriaL, a randomized trial of cancer and cardiovascular disease prevention among 25,871 adults. EXPOSURE: Racial and ethnic group (Non-Hispanic White, Black, Hispanic, Asian and Others/unspecified). MAIN OUTCOMES AND MEASURES: Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8); participants reported diagnosis and medication and/or counseling for depression. Differences across racial/ethnic groups were evaluated using: multivariable zero-inflated negative binomial regression to compare PHQ-8 scores; multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25,503 participants with adequate depression data (mean [standard deviation] age=67.1 [7.1] years), including: 12888 [50.5%] female, 17828 [69.9%] non-Hispanic White, 5004 [19.6%] Black, 1001 [3.9%] Hispanic, 377 [1.5%] Asian and 1293 [5.1%] Other-reporting/race-unspecified participants. After adjustment for sociodemographic, lifestyle and health confounders, compared to non-Hispanic Whites: Black participants had a 8% higher severity level of PHQ-8 scores (IRR (incidence rate ratio)=1.08, 95% CI: 1.02-1.15; p=0.01); Hispanic participants had 26% higher severity of PHQ-8 (IRR=1.26, 95% CI: 1.12-1.42; p Conclusions In this large cross-sectional study, we observed significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care, after adjustment for numerous confounders. Findings suggest a need for further examination of novel patient- and provider-level factors underlying these associations. This research was funded by: VITAL-DEP is supported by R01 MH091448 from NIMH.