Skip to main content

Socioeconomic status and survival among older adults with dementia and depression

  • Ruoling Chen (a1), Zhi Hu (a2), Li Wei (a3) and Kenneth Wilson (a4)

People from lower socioeconomic groups have a higher risk of mortality. The impact of low socioeconomic status on survival among older adults with dementia and depression remains unclear.


To investigate the association between socioeconomic status and mortality in people with dementia and late-life depression in China.


Using Geriatric Mental Status – Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) we interviewed 2978 people aged ⩾60 years in Anhui, China. We characterised baseline socioeconomic status and risk factors and diagnosed 223 people with dementia and 128 with depression. All-cause mortality was followed up over 5.6 years.


Individuals with dementia living in rural areas had a three times greater risk of mortality (multivariate adjusted hazard ratio (HR) = 2.96, 95% CI 1.45–6.04) than those in urban areas, and for those with depression the HR was 4.15 (95% CI 1.59–10.83). There were similar mortality rates when comparing people with dementia with low v. high levels of education, occupation and income, but individuals with depression with low v. high levels had non-significant increases in mortality of 11%, 50% and 55% respectively.


Older adults with dementia and depression living in rural China had a significantly higher risk of mortality than urban counterparts. Interventions should be implemented in rural areas to tackle survival inequality in dementia and depression.

Corresponding author
Ruoling Chen, Division of Health and Social Care Research, King's College London, 7th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK. Email:
Hide All

The study was supported by research grants from the BUPA Foundation, UK (45/NOV/06, and TBF-M09-05) and Anhui Province Natural Science Fund, China. The sponsors of the study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The opinions expressed in this report are not necessarily those of the funders.

Declaration of interest


Hide All
1 World Health Organization. Disease Incidence, Prevalence and Disability. The Global Burden of Disease. WHO, 2004.
2 Barnes, DE, Yaffe, K. The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol 2011; 10: 819–28.
3 Beekman, AT, Copeland, JR, Prince, MJ. Review of community prevalence of depression in later life. Br J Psychiatry 1999; 174: 307–11.
4 Dewey, ME, Saz, P. Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001; 16: 751–61.
5 Saz, P, Dewey, ME. Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001; 16: 622–30.
6 Sprague, BL, Trentham-Dietz, A, Gangnon, RE, Ramchandani, R, Hampton, JM, Robert, SA, et al. Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer 2011; 117: 1542–51.
7 Addo, J, Ayerbe, L, Mohan, KM, Crichton, S, Sheldenkar, A, Chen, R et al. Socioeconomic status and stroke: an updated review. Stroke 2012; 43: 1186–91.
8 Chen, R, McKevitt, CJ, Rudd, AG, Wolfe, CDA. Socioeconomic deprivation and survival after stroke: findings from the Prospective South London Stroke Register of 1995–2011. Stroke, 2013; 21 Nov (epub ahead of print).
9 Beeri, MS, Goldbourt, U. Late-life dementia predicts mortality beyond established midlife risk factors. Am J Geriatr Psychiatry 2011; 19: 7987.
10 Aneshensel, CS, Pearlin, LI, Levy-Storms, L, Schuler, RH. The transition from home to nursing home mortality among people with dementia. J Gerontol B Psychol Sci Soc Sci 2000; 55: S15262.
11 Meng, X, D'Arcy, C, Tempier, R, Kou, C, Morgan, D, Mousseau, DD. Survival of patients with incident dementia who had a pre-existing psychiatric disorder: a population-based 7-year follow-up study. Int J Geriatr Psychiatry 2012; 27: 683–91.
12 Valenzuela, M, Brayne, C, Sachdev, P, Wilcock, G, Matthews, F. Cognitive lifestyle and long-term risk of dementia and survival after diagnosis in a multicenter population-based cohort. Am J Epidemiol 2011; 173: 1004–12.
13 Llibre Rodriguez, JJ, Ferri, CP, Acosta, D, Guerra, M, Huang, Y, Jacob, KS, et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet 2008; 372: 464–74.
14 Chan, KY, Wang, W, Wu, JJ, Liu, L, Theodoratou, E, Car, J, et al. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990–2010: a systematic review and analysis. Lancet 2013; 381: 2016–23.
15 Woo, J, Kwok, T, Sze, FK, Yuan, HJ. Ageing in China: health and social consequences and responses. Int J Epidemiol 2002; 31: 772–5.
16 Chen, R, Hu, Z, Qin, X, Xu, X, Copeland, JR. A community-based study of depression in older people in Hefei, China–the GMS-AGECAT prevalence, case validation and socio-economic correlates. Int J Geriatr Psychiatry 2004; 19: 407–13.
17 Chen, R, Wei, L, Hu, Z, Qin, X, Copeland, JR, Hemingway, H. Depression in older people in rural China. Arch Intern Med 2005; 165: 2019–25.
18 Chen, R, Hu, Z, Chen, RL, Ma, Y, Zhang, D, Wilson, K. Determinants for undetected dementia and late-life depression. Br J Psychiatry 2013; 203: 203–8.
19 Copeland, JR, Prince, M, Wilson, KC, Dewey, ME, Payne, J, Gurland, B. The Geriatric Mental State Examination in the 21st century. Int J Geriatr Psychiatry 2002; 17: 729–32.
20 Wilson, KC, Chen, R, Taylor, S, McCracken, CF, Copeland, JR. Socio-economic deprivation and the prevalence and prediction of depression in older community residents. The MRC-ALPHA Study. Br J Psychiatry 1999; 175: 549–53.
21 Chen, R, Tunstall-Pedoe, H. Socioeconomic deprivation and waist circumference in men and women: the Scottish MONICA surveys 1989–1995. Eur J Epidemiol 2005; 20: 141–7.
22 Copeland, JR, Chen, R, Dewey, ME, McCracken, CF, Gilmore, C, Larkin, B, et al. Community-based case–control study of depression in older people. Cases and sub-cases from the MRC-ALPHA Study. Br J Psychiatry 1999; 175: 340–7.
23 Chen, R, Ma, Y, Wilson, K, Hu, Z, Sallah, D, Wang, J, et al. A multicentre community-based study of dementia cases and subcases in older people in China–the GMS-AGECAT prevalence and socio-economic correlates. Int J Geriatr Psychiatry 2012; 27: 692702.
24 Saunders, PA, Copeland, JR, Dewey, ME, Gilmore, C, Larkin, BA, Phaterpekar, H, et al. The prevalence of dementia, depression and neurosis in later life: the Liverpool MRC-ALPHA Study. Int J Epidemiol 1993; 22: 838–47.
25 Kua, EH. A community study of mental disorders in elderly Singaporean Chinese using the GMS-AGECAT package. Aust N Z J Psychiatry 1992; 26: 502–6.
26 Prince, M, Acosta, D, Chiu, H, Copeland, J, Dewey, M, Scazufca, M, et al. Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm. Br J Psychiatry 2004; 185: 429–36.
27 Chen, R, Hu, Z, Wei, L, Ma, Y, Liu, Z, Copeland, JR. Incident dementia in a defined older chinese population. PLoS ONE 2011; 6: e24817.
28 Chen, R, Hu, Z, Wei, L, Qin, X, McCracken, C, Copeland, JR. Severity of depression and risk for subsequent dementia: cohort studies in China and the UK. Br J Psychiatry 2008; 193: 373–7.
29 Chen, R, Hu, Z, Wei, L, Qin, X, Copeland, JR. Is the relationship between syndromes of depression and dementia temporal? The MRC-ALPHA and Hefei-China studies. Psychol Med 2009; 39: 425–30.
30 Altman, DG, Bland, JM. Interaction revisited: the difference between two estimates. BMJ 2003; 326: 219.
31 Woo, J, Ho, SC, Lau, J, Yuen, YK, Chiu, H, Lee, HC, et al. The prevalence of depressive symptoms and predisposing factors in an elderly Chinese population. Acta Psychiatr Scand 1994; 89: 813.
32 Copeland, JR, Beekman, AT, Dewey, ME, Hooijer, C, Jordan, A, Lawlor, BA, et al. Depression in Europe. Geographical distribution among older people. Br J Psychiatry 1999; 174: 312–21.
33 Copeland, JR, McCracken, CF, Dewey, ME, Wilson, KC, Doran, M, Gilmore, C, et al. Undifferentiated dementia, Alzheimer's disease and vascular dementia: age- and gender-related incidence in Liverpool. The MRC-ALPHA study. Br J Psychiatry 1999; 175: 433–8.
34 Krijthe, BP, Walter, S, Newson, RS, Hofman, A, Hunink, MG, Tiemeier, H. Is positive affect associated with survival? A population-based study of elderly persons. Am J Epidemiol 2011; 173: 1298–307.
35 Hanninen, T, Hallikainen, M, Tuomainen, S, Vanhanen, M, Soininen, H. Prevalence of mild cognitive impairment: a population-based study in elderly subjects. Acta Neurol Scand 2002; 106: 148–54.
36 Bassuk, SS, Wypij, D, Berkman, LF. Cognitive impairment and mortality in the community-dwelling elderly. Am J Epidemiol 2000; 151: 676–88.
37 Penninx, BW, Geerlings, SW, Deeg, DJ, van Eijk, JT, Van, TW, Beekman, AT. Minor and major depression and the risk of death in older persons. Arch Gen Psychiatry 1999; 56: 889–95.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Chen et al. supplementary material
Supplementary Tables S1-S3

 PDF (46 KB)
46 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 12 *
Loading metrics...

Abstract views

Total abstract views: 38 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 19th March 2018. This data will be updated every 24 hours.

Socioeconomic status and survival among older adults with dementia and depression

  • Ruoling Chen (a1), Zhi Hu (a2), Li Wei (a3) and Kenneth Wilson (a4)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *