Gender difference in cognitive health among older Indian adults: A cross-sectional multilevel analysis

This study assesses the gender gap in cognitive health among older adults in India and examines the extent to which individual, household and state level characteristics contribute to the male-female difference in cognitive health. The study is based on 6548 women and men who participated in the WHO Study on Global AGEing and Adult Health conducted in six states in India during 2007-08. Multilevel ordinary least square regression was used to examine the gender difference in cognitive health, adjusting for individual, household, health behavior and state-level variables. A composite cognitive score (CCS) was calculated by combining z-scores of five individual cognitive tests. Results suggest that CCS is worse among women than among men after adjusting for individual and state level factors. The largest reduction in the gender gap in CCS was observed when adjusting for education, followed by other individual factors such as marital status, individual height, caste, religion, tobacco consumption and chronic health status. Although state level urbanization and female workforce participation rate were significantly associated with CCS, these characteristics did not contribute to the reduction of gender difference in CCS. This study extends the current knowledge of women's disadvantage in cognitive health, demonstrating that individual level characteristics remain key determinants of gender difference in cognition among older adults in India. Importantly, this relationship holds in the context of very large cross-state variations in cognitive health and its determinants.