Regular Research Article| Volume 30, ISSUE 6, P703-716, June 2022

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Geographic Region, Racial/Ethnic Disparities, and Late-Life Depression: Results From a Large US Cohort of Older Adults

Published:November 26, 2021DOI:


      • What is the primary question addressed by this study? What are the associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment, and how do associations between race/ethnicity and LLD outcomes, previously observed in the overall sample, vary by geographic region?
      • What is the main finding of this study? We observed significant regional differences in LLD severity and item-level symptom burden, but not in treatment. Lower levels of LLD severity and item-level symptom burden were observed in the Midwest compared to the Northeast. Magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
      • What is the meaning of the finding? LLD varied by geographic region. Furthermore, geographic region may play an important role in patterns of racial/ethnic disparities in LLD outcomes.



      To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region.


      We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed.


      Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions.


      LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.

      Key Words

      List of abbreviations:

      LLD (Late-life depression), US (United States), PA (Physical activity), PHQ (Patient health questionnaire), ZINB (Zero inflated negative binomial), FDR (False discovery rate), VITAL (VITamin D and OmegA-3 TriaL), VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention)
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