Supplementary file 1_Persistent socio-demographic inequalities in depression among older adults in China during and after COVID-19: a systematic review and meta-analysis.docx

Pooled prevalence fluctuated across investigation years, from 16.6% (95% CI 12.1–22.4) in 2022 to 22.9% (95% CI 18.3–28.3) in 2024–2025, with substantial between-study heterogeneity (overall I² = 99.55%). Higher odds of depressive symptoms were observed among women, unmarried older adults, rural residents, those living alone and those with lower educational attainment. The largest disparities were related to education (OR 1.693, 95% CI 1.388–2.060), living arrangement (OR 1.671, 95% CI 1.437–1.945) and marital status (OR 1.652, 95% CI 1.467–1.860).

Year-level analyses suggested limited temporal variation overall: marital-status-related inequality showed a small upward trend, whereas living-arrangement-related inequality showed a non-significant tendency toward attenuation. No broad systematic restructuring was observed.</p>Conclusion<p>Depressive symptoms among older adults in China fluctuated across the pandemic and post-pandemic periods, while socio-demographic inequalities remained broadly stable.

Major public health disruption appeared more likely to expose and prolong pre-existing inequalities than fundamentally reshape them in the short term. These findings provide a useful comparative reference for understanding mental health vulnerability in aging societies facing public health emergencies.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/view/CRD42025642200; identifier: CRD42025642200.</p>