Delayed Healthcare and Follow-up Depressive Symptoms Among Middle-Aged and Older Chinese Adults: A National Cohort Analysis

Abstract Background Delayed healthcare may be an important marker of access barriers and health vulnerability in later life, but evidence on depressive symptoms in China remains limited. We examined the association between delayed healthcare and depressive symptoms assessed at follow-up among middle-aged and older Chinese adults who were free of depressive symptoms at baseline. Methods We conducted a national cohort analysis using 2018 and 2020 China Health and Retirement Longitudinal Study data. Participants had a complete 2018 CES-D-10 assessment, no baseline depressive symptoms (score < 10), and a valid 2020 assessment. Delayed healthcare and depressive symptoms were both assessed in 2020. Modified Poisson regression with community-clustered robust variance estimated prevalence ratios (PRs). Fully adjusted models included baseline sociodemographic characteristics, depressive symptom score, health status, pain, functional limitation, alcohol use, and prior healthcare use. Attrition-weighted, baseline-survey-weighted, complete-case, and three-prior-wave depression-free analyses assessed robustness. Results Among 8,412 participants (mean age 59.8 years; 46.2% female), 772 (9.2%) reported delayed healthcare and 1,886 (22.4%) had depressive symptoms in 2020. The crude prevalence difference was 10.4 percentage points (31.9% vs 21.5%). Delayed healthcare was associated with a higher prevalence of depressive symptoms after full adjustment (PR 1.23, 95% CI 1.11–1.37; P < 0.001). The estimate was similar after attrition weighting (PR 1.23, 95% CI 1.11–1.37) and in complete-case analysis (PR 1.23, 95% CI 1.11–1.37); it remained elevated in participants free of depressive symptoms at all three earlier waves (PR 1.27, 95% CI 1.04–1.55). Conclusions Delayed healthcare was associated with a higher prevalence of depressive symptoms at follow-up in this national cohort. Timely access to care may be a clinically relevant component of mental-health risk recognition for middle-aged and older adults. Because delayed healthcare and depressive symptoms were measured in the same survey round, the findings are associative and do not establish temporal ordering or causality.