Sex Differences in Cognitive Health Among Older Adults in India

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.