Examining the influence of marital status on cognitive risk in a nationally representative sample of adults in India

Abstract

AbstractBackgroundInfluence of marital status on cognitive risk remains understudied in India with 17.7% of the global population.MethodsTo examine the influence of marital status (categorized as married, never married, widowed and other which included partnered, separated or divorced) on cognitive risk and to what extent marital status is a protective factor for cognitive decline. For this observational study design, we merged nationally representative harmonized Longitudinal Aging Study of India (LASI) and the harmonized Diagnostic Assessment of Dementia (LASI‐DAD) for 4096 adults 45 years and older and their spouses regardless of age from 2017 to 2019. We accounted for multistage, stratified, area probability cluster design of the complex survey using appropriate weights. The primary outcome was cognitive impairment based on cognition score without number series based on word recall, cognition tests and Jorm IQ code < 3.9 or > 3.9 or higher. The cognitive impairment was constructed as a 0/1 dummy variable coded 0 if the respondent was at low‐risk (mid‐tertile) or very low‐risk (top‐tertile) and coded 1 if the respondent was high‐risk (bottom‐tertile). We assessed proportion at risk for cognitive impairment by marital status and used chi‐square test to test significance at p<0.05 level. We ran logistic regression model on weighted population to examine the odds ratio of cognitive risk by marital status.ResultsOur weighted population was 4,716 adults, 64.0% were married, 0.93% were never married, 33.3% were widowed, and 1.8% were other. Those married had the lowest proportion of cognitive risk (43.0%) while never married had the highest proportion of cognitive risk (71.0%), followed by widowed (59.6%) and other (55.0%). In logistic regression, in comparison to married adults, cognitive risk was three times more likely for never married adults, AOR 3.17 [95% CI, 1.55‐6.48], and nearly two times more likely for widowed, AOR 1.58 [95% CI, 1.33‐1.88].ConclusionMarital status likely functions as a social determinant of cognitive decline in the Indian context. These findings are relevant to U.S. and other countries as the harmonized LASI, is a sister study of the harmonized U.S. Health and Retirement Study and data can be leveraged using cross‐country comparisons.