Older Chinese adults with dementia and depression have a significantly higher risk of mortality

March 14, 2014, King's College London
China dementia warning

(Medical Xpress)—Older adults with dementia and depression living in rural China have a significantly higher risk of mortality than their urban counterparts, according to a new report by UK and Chinese scientists.

The study, published in the British Journal of Psychiatry, found that individuals in rural areas with had a three times higher risk of mortality compared to those in urban areas. For people with depression in rural areas there was about a four times greater risk of mortality.

The authors suggest that mental health interventions and investment in rural medical care and insurance should be implemented to tackle survival inequality.

Dementia and depression are highly prevalent in people aged over 60. It is estimated that globally around 40-50 million people are living with dementia and 50 million older adults have depression, with evidence that they have significantly reduced survival rates.

Previous studies have suggested that people with low socioeconomic status have an increased risk of mortality from dementia and late-life depression, but until now there has been lack of data from low- and middle-income countries on the association.

Since China's economic reforms of the 1980s, there has been a growing disparity in socioeconomic status between rural and urban areas. People living in rural areas have an average annual income that is two to five times lower than those in towns and cities.

Dr Ruoling Chen from King's College London and colleagues from Anhui Medical University set out to examine the impact of (indicated by levels of education, occupation and income) and living in a rural area on survival among older adults with dementia and depression.

They carried out research in Anhui province, China, interviewing 2,978 people aged over 60 living in rural and urban areas. General health, mental state and risk factors for depression and dementia were assessed, as well as baseline – using factors such as educational level, occupational class, income and rural versus urban living.

The team diagnosed 223 people with dementia and 128 with depression. Over five and a half years they followed up to investigate rates of mortality across the group.

The team found a significant association between the rural–urban variable and dementia or depression, with dementia and late-life depression significantly associated with increased mortality.

Dr Ruoling Chen, senior lecturer in public health, module leader of MPH Global Public Health and PhD supervisor from King's College London, said: 'In China rural residents have little medical insurance, unlike those in towns and cities who have medical coverage provided by the government or their employers. People in rural China also lack medical facilities and healthcare compared with their urban counterparts.

'Our data suggest that there may be an unequal distribution of mental healthcare between rural and urban areas, which needs to be urgently tackled. These findings should act as a warning to governments and healthcare professionals to reduce mental health inequalities.'

Co-author Professor Zhi Hu, School of Health Administrations, Anhui Medical University, said: 'In China, people living in urban areas have much better access to community health services and social support from their families, and a family doctor often provides services to older people.

In contrast, many older people in rural areas, who would typically rely on their children for support, may have a lower level of care because the children have moved to for a job.'

The authors suggest that innovative primary and secondary care strategies targeting people in are required, along with effective measures to promote the uptake of mental health interventions, including relatively simple strategies such as social support in lower socioeconomic groups.

They conclude that investments in rural medical care and insurance and the introduction of new mental healthcare systems from high-income countries, with evidence-based dementia and depression services for , should be considered to help to reduce mortality for individuals with both early and established cases of dementia and late-life .

Explore further: Over 90 percent of dementia cases in China are undetected

More information: Ruoling Chen, Zhi Hu, Li Wei, and Kenneth Wilson, "Socioeconomic status and survival among older adults with dementia and depression." BJP bjp.bp.113.134734; published ahead of print February 13, 2014, DOI: 10.1192/bjp.bp.113.134734

Related Stories

Over 90 percent of dementia cases in China are undetected

July 25, 2013
An international team of researchers has found that over 90 percent of dementia cases in China go undetected, with a high level of undiagnosed dementia in rural areas. The team of public health experts led by Dr Ruoling Chen ...

Women in large urban areas at higher risk of postpartum depression

August 6, 2013
Women living in large urban centres in Canada with more than 500 000 inhabitants were at higher risk of postpartum depression than women in other areas, according to a study in CMAJ (Canadian Medical Association Journal).

Hospitalization increases risk of depression and dementia for seniors

February 28, 2014
People over age 65 who have been hospitalized are at significantly greater risk for dementia or depression, finds a new study in General Hospital Psychiatry.

Rural primary care physicians offer insight into rural women's health care

February 5, 2014
Women living in rural communities are less likely than urban-dwelling women to receive sufficient mental health care, in large part due to limited access to services and societal stigma, according to medicine and public health ...

Gap in life expectancy between rural and urban residents is growing

January 24, 2014
Reducing health inequalities and increasing life expectancy in the United States have both been primary goals of the national health initiative, Healthy People 2020. Unfortunately, according to a new study in the American ...

Cancer survivors in rural areas forgo health care because of cost

October 4, 2013
Older cancer survivors living in rural areas were more likely to forgo medical and dental care because of financial concerns compared with older cancer survivors living in urban areas, according to a study published in Cancer ...

Recommended for you

Intensive behavior therapy no better than conventional support in treating teenagers with antisocial behavior

January 19, 2018
Research led by UCL has found that intensive and costly multisystemic therapy is no better than conventional therapy in treating teenagers with moderate to severe antisocial behaviour.

Babies' babbling betters brains, language

January 18, 2018
Babies are adept at getting what they need - including an education. New research shows that babies organize mothers' verbal responses, which promotes more effective language instruction, and infant babbling is the key.

College branding makes beer more salient to underage students

January 18, 2018
In recent years, major beer companies have tried to capitalize on the salience of students' university affiliations, unveiling marketing campaigns and products—such as "fan cans," store displays, and billboard ads—that ...

Inherited IQ can increase in early childhood

January 18, 2018
When it comes to intelligence, environment and education matter – more than we think.

Modulating molecules: Study shows oxytocin helps the brain to modulate social signals

January 17, 2018
Between sights, sounds, smells and other senses, the brain is flooded with stimuli on a moment-to-moment basis. How can it sort through the flood of information to decide what is important and what can be relegated to the ...

Baby brains help infants figure it out before they try it out

January 17, 2018
Babies often amaze their parents when they seemingly learn new skills overnight—how to walk, for example. But their brains were probably prepping for those tasks long before their first steps occurred, according to researchers.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.