BackgroundLate-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.MethodWe conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.ResultsA total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.ConclusionLate-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

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IMPORTANCE Several Medicare alternative payment models were implemented in recent years, but their implications for socioeconomic gaps in postacute care (PAC) are unknown.OBJECTIVES To determine the longitudinal trends in PAC use and outcomes after hip and knee replacements and in gaps among 3 groups: Medicare-only patients, dual-eligible patients with full Medicaid benefits, and dual-eligible patients with partial Medicaid benefits.

Rural-urban inequalities in health status and access to care are a significant issue in China, especially among older adults. However, the rural-urban differences in health outcomes, healthcare use, and expenditures among insured elders following China's comprehensive healthcare reforms in 2009 remain unclear. Using the Chinese Longitudinal Healthy Longevity Surveys data containing a sample of 2,624 urban and 6,297 rural residents aged 65 and older, we performed multivariable regression analyses to determine rural-urban differences in physical and psychological functions, self-reported access to care, and healthcare expenditures, after adjusting for individual socio-demographic characteristics and health conditions. Nonparametric tests were used to evaluate the changes in rural-urban differences between 2011 and 2014. Compared to rural residents, urban residents were more dependent on activities of daily living (ADLs) and instrumental ADLs. Urban residents reported better adequate access to care, higher adjusted total expenditures for inpatient, outpatient, and total care, and higher adjusted out-of-pocket spending for outpatient and total care. However, rural residents had higher adjusted self-payment ratios for total care. Rural-urban differences in health outcomes, adequate access to care, and self-payment ratio significantly narrowed, but rural-urban differences in healthcare expenditures significantly increased from 2011 to 2014. Our findings revealed that although health and healthcare access improved for both rural and urban older adults in China between 2011 and 2014, rural-urban differences showed mixed trends. These findings provide empirical support for China's implementation of integrated rural and urban public health insurance systems, and further suggest that inequalities in healthcare resource distribution and economic development between rural and urban areas should be addressed to further reduce the rural-urban differences.