Cognitively healthy life expectancy of older women and men in India

Rapid population aging and increasing life expectancy in India, the most populous country in the world, raise questions about the quality of these added years for older adults. Cognitive impairment, in particular, is a growing public health concern in India. We estimated cognitively healthy life expectancy (CHLE) and life expectancy with mild cognitive impairment and dementia at age 60 and 70 years using life tables from the Sample Registration System and Demographic and Health Surveys, linked with cognitive health data from the Longitudinal Aging Study in India - Diagnostic Assessment of Dementia (LASI-DAD; 2017-2019). Analyses were stratified by gender, rural-urban residence, and social group (Scheduled Caste or Scheduled Tribe [SC/ST], Other Backward Classes, and high caste). Conditional on surviving to age 60, CHLE for women was only 0.86 years higher than for men. Larger differences in CHLE between groups emerge when examined by place of residence and social group. Compared to their urban counterparts, rural women and men had 2.2 and 3.1 fewer years of CHLE, respectively. In relative terms, rural women spent 4 percentage points less of their remaining life cognitively healthy, while rural men spent 8 percentage points less. By social group, SC/ST women and men lived 3.7 and 5.3 fewer cognitively healthy years than high-caste women and men, respectively, or 5 and 12 percentage points fewer in relative terms. Decomposition analyses indicated that subgroup differences in CHLE at age 60 are driven primarily by mortality rather than differences in the prevalence of cognitive impairment.