African American Ethnicity and Diabetes Independently Predict Co-Occurring Depression and Hypertension Among Older Adult African Americans

Background and Purpose: Although hypertension and depression are common among older adults and synergistic, there has been limited research on co-occurring hypertension and depression among older adults. The objectives of this study were to estimate the prevalence of co-occurring hypertension and depression among community-dwelling older adults and to examine predictors of co-occurring hypertension among community-dwelling older adults.

Methods: This study conducted a secondary analysis of epidemiologic data collected by an Alabama Medicaid Agency-funded project known as Charting the Course. The project was a long-term care needs assessment of community-dwelling older adults (n=1,204) living in the state of Alabama. Measures of central tendency and frequency distributions were used to characterize the sample. Chi-square and the Student’s t-test were used to compare older adults with and without co-occurring depression and hypertension on dichotomous and continuous variables. Binomial logistic regression was used to examine predictors of co-occurring depression and hypertension.

Results: The prevalence of co-occurring depression and hypertension among older adults was 35%, and the prevalence of co-occurring depression and hypertension was highest among African Americans (40%). African American ethnicity (OR=1.690, CI: 1.221 - 2.341) and diabetes (OR=1.668, CI: 1.173 - 2.372) were positively associated with co-occurring depression and hypertension. Income ≥$20,000 (OR=0.544, CI: 0.400 - 0.739), ≥3 meals on average per day (OR=0.576, CI: 0.429-0.774), and higher self-ratings of general health (OR=0.728, CI: 0.628 - 0.843) and physical activity (OR=0.827, CI: 0.694 - 0.986) were negatively associated with co-occurrence.

Conclusions and Implications: Co-occurring depression and hypertension was alarmingly high among older adults. Older adults who were African American or diabetic were 1.690 and 1.668 times more likely to have co-occurring depression and hypertension, respectively. The notable difference in the likelihood of co-occurring depression and hypertension is representative of a racial health disparity that largely disfavors African American older adults. The findings suggest a need for an examination of the etiology of this health disparity that disproportionately impacts African American older adults. Culturally-sensitive interventions are needed to increase awareness of co-occurring depression and hypertension among older adult African Americans and to eliminate the disparity. Though quantitative approaches can further characterize the disparity, qualitative approaches that incorporate patient input would be ideal in tackling the disparity. Otherwise, older adult African Americans will continue to suffer from increases in annual incident cases of co-occurring depression and hypertension.