Examining rural-urban differences in pain-depression comorbidity and its association with elder abuse: Multivariable decomposition analysis of nationally representative cross-sectional survey

Background

This study investigates rural–urban differences in Pain-Depression Comorbidity (PDC) and its association with elder abuse among older adults in India. It aims to identify the socio-demographic, functional and behavioural health predictors contributing to PDC and elder abuse.

Data and methods

Data were drawn from LASI, 2017–18 survey, comprising 30,772 individuals aged 60+. Pain, depressive symptoms (CES-D-10) and elder abuse were defined based on self-reported data. Covariates on socio-demographic, functional and behavioural health were included. Descriptive statistics, chi-square tests, nested-multilevel logistic-regression models and multivariable-decomposition analysis were used to quantify rural–urban disparities in PDC.

Results

The prevalence of PDC was higher among rural older adults (15 %) compared to their urban counterparts (11 %). A significant association between elder abuse and PDC was observed in both rural and urban areas. The odds of experiencing PDC were significantly higher among individuals reporting elder abuse, with a stronger association in urban areas (AOR = 2.53) than in rural areas (AOR = 1.78). Decomposition analysis shows that 66 % of the rural–urban gap in PDC was attributed to differences in observed characteristics, particularly education, caste, functional health, living arrangement and elder abuse.

Conclusion

This study offers important insights into the interrelationship between elder abuse and PDC in India, revealing substantial rural–urban disparities. The findings highlight the urgent need for residence-specific public health strategies to address the dual burden of pain and depression among older adults. Targeted interventions, especially in rural areas, should focus on education, functional-health and the prevention of elder abuse.