Examining rural-urban differences in pain-depression comorbidity and its association with elder abuse: Multivariable decomposition analysis of nationally representative cross-sectional survey

Background: This study investigates rural–urban differences in Pain-Depression Comorbidity (PDC) and its association with elder abuse among older adults in India. It aims to identify the socio-demographic, functional and behavioural health predictors contributing to PDC and elder abuse. Data and methods: Data were drawn from LASI, 2017–18 survey, comprising 30,772 individuals aged 60+. Pain, depressive symptoms (CES-D-10) and elder abuse were defined based on self-reported data. Covariates on socio-demographic, functional and behavioural health were included. Descriptive statistics, chi-square tests, nested-multilevel logistic-regression models and multivariable-decomposition analysis were used to quantify rural–urban disparities in PDC. Results: The prevalence of PDC was higher among rural older adults (15 %) compared to their urban counterparts (11 %). A significant association between elder abuse and PDC was observed in both rural and urban areas. The odds of experiencing PDC were significantly higher among individuals reporting elder abuse, with a stronger association in urban areas (AOR = 2.53) than in rural areas (AOR = 1.78). Decomposition analysis shows that 66 % of the rural–urban gap in PDC was attributed to differences in observed characteristics, particularly education, caste, functional health, living arrangement and elder abuse. Conclusion: This study offers important insights into the interrelationship between elder abuse and PDC in India, revealing substantial rural–urban disparities. The findings highlight the urgent need for residence-specific public health strategies to address the dual burden of pain and depression among older adults. Targeted interventions, especially in rural areas, should focus on education, functional-health and the prevention of elder abuse.