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Sex Differences in Cognitive Health Among Older Adults in India
Author(s) -
Angrisani Marco,
Jain Urvashi,
Lee Jinkook
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16732
Subject(s) - medicine , numeracy , gerontology , dementia , cognition , socioeconomic status , demography , literacy , cognitive test , population , disease , environmental health , psychology , psychiatry , pedagogy , pathology , sociology
OBJECTIVES To document sex differences in late‐life cognitive function and identify their early‐life determinants among older Indian adults. DESIGN Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI‐DAD). SETTING Individual cognitive testing in hospital or household setting across 14 states of India. PARTICIPANTS Individuals aged 60 years and older from LASI‐DAD (2017–2019) (N = 2,704; 53.5% female). MEASUREMENTS Given the low levels of literacy and numeracy among older Indian adults, we consider two composite cognitive scores as outcome variables. Score I is based on tests that do not require literacy or numeracy, whereas score II is based on tests that require such skills. Ordinary least squares is used to estimate models featuring a progressively increasing number of covariates. We add to the baseline specification, including a sex dummy, age, and state indicators, measures of early‐life socioeconomic status (SES), early‐life nutrition, as proxied by knee height, and education. RESULTS Across most cognitive domains, women perform significantly worse than for men: −0.4 standard deviations (SD) for score I and −0.8 SD for score II. Early‐life SES, health, and education explain 90% of the gap for score I and 55% for score II. Results are similar across hospital‐based and home testing. CONCLUSION In India, lower levels of early‐life human capital investments in nutrition and education among women compared with men are associated with a female disadvantage in late‐life cognitive health. This has important implications for public health policy, aiming at reducing the risk of cognitive decline and dementia—a nascent concern in India. J Am Geriatr Soc 68:S20‐S28, 2020.