Socioeconomic gradients and functional vulnerability in late-life depressive symptoms: design-consistent, age-standardized evidence from HRS 2022

Background Survey-design–consistent estimates of late-life depressive symptoms vary across studies due to heterogeneous thresholds, incomplete handling of complex sampling, and shifting age structures.
Methods Using HRS 2022 public data, we analyzed adults aged ≥60 (non-proxy interviews). Depressive symptoms were defined by CES-D-8≥4 (primary), with sensitivity at ≥3 and ≥5. Prevalence and 95% CIs were estimated with full survey design preservation (weights/strata/PSUs; Taylor linearization). We characterized distributions by sex, education (4 levels), weighted income quintiles (Q1–Q5, with explicit “income missing”), ADL/IADL limitation, and multimorbidity (≥2). Direct age standardization aligned 2020 to the 2022 age structure. Additive interaction (IADL × multimorbidity) was summarized via RERI, AP, and S.
Results In 2022, design-consistent prevalence was 12.62% (men 9.92%, women 14.87%). Clear socioeconomic gradients were observed (higher in