Trends and disparities in depression-related mortality among older adults in the United States, 1999–2020

Background National trends in mortality with depression recorded as the underlying cause among older adults remain insufficiently characterized. We examined recorded mortality and demographic and geographic disparities among U.S. adults aged ≥65 years during 1999–2020. Methods CDC WONDER Underlying Cause of Death data were used to identify deaths with ICD-10 F32 or F33 as the underlying cause. Age-adjusted mortality rates (AAMRs) per 100,000 population and age-specific rates were calculated. Joinpoint regression assessed temporal trends, ARIMA generated exploratory projections through 2030, and Frontier analysis provided descriptive state-level benchmarking. Sensitivity analyses examined any mention of F32/F33 in multiple-cause-of-death records and trends after excluding 2020. Results The primary analysis identified 11,858 deaths, with an overall AAMR of 1.29 per 100,000. Higher recorded rates were observed among women, non-Hispanic and White older adults, nonmetropolitan residents, and residents of the Midwest. Overall AAMR declined (AAPC, −3.26%; p < 0.001), most sharply during 2003–2007; the 2018–2020 increase was not statistically significant. A long-term decline remained after excluding 2020. The broader multiple-cause definition identified 236,831 deaths, 19.97 times the primary count, and showed a different late-period pattern. ARIMA projected declining rates. Frontier analysis showed substantial state-level heterogeneity. Conclusion Mortality with depression recorded as the underlying cause declined, but the broader any-mention definition yielded different trends. Continued surveillance, equitable recognition and documentation, and culturally responsive geriatric mental health care remain important.