Socioeconomic inequality in cognitive impairment among India’s older adults and its determinants: a decomposition analysis

Abstract

Background: Cognitive impairment (CoI) is a significant risk factor for ill-health status among the older adults and a major burden on public health. This study unearths the degree of socioeconomic inequalities and assesses the determinants of CoI among the older adults in India. Methods: Data on cognitive impairment of older adults aged 60 + years (n = 31,646) gathered in a nationally representative Longitudinal Ageing Study in India (2017–18) was analyzed through STATA with a significance level of 5%. Binary logistic regression, the concentration index, concentration curve, and Shapley decomposition analysis were performed to assess the socioeconomic inequalities and the determinants of CoI. Results: Sixteen percent of the older adults had CoI. Females (OR = 1.88, 95% CI = 1.70–2.09), those aged 80 plus years (OR = 3.98, 95%CI = 3.56–4.44), from ST (OR = 2.65, 95%CI = 2.32–3.02), with perceived poor health (OR = 1.61,95%CI = 1.45–1.79), with depression (OR = 1.32, 95%CI = 1.21–1.43), with no schooling (OR = 16.46, 95%CI = 11.31–23.97) with 1 + ADL (OR = 1.43, 95%CI = 1.31–1.57) and 1 + IADL (OR = 1.30, 95%CI = 1.19–1.41) had higher odds of CoI than their respective counterparts. Older adults from urban areas (OR = 0.63, 95%CI = 0.57–0.70), higher income groups (OR = 0.61, 95%CI = 0.53- 0.70) and higher education level with sources of financial support (OR = 0.68, 95%CI = 0.61- 0.76) less likely to experience CoI. Economic inequalities exist in the distribution of CoI-the poorest being the most disadvantaged (concentration index value = -0.118). Conclusions: There are socioeconomic-related inequalities in CoI among the older adults. The socioeconomically vulnerable older adults, including those illiterates, with poor economic status, women, not-in-union, the older, and those without social support, are more likely to develop CoI. The results suggest awareness generation and more customized policies and programs to reduce the socioeconomic inequalities in CoI among the older adults in India. The improved mental health of the older adults will contribute to achieving Sustainable Development Goals, including Goal 3 on guaranteeing good health and well-being for all.