Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study.

TitleComparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study.
Publication TypeJournal Article
Year of Publication2023
AuthorsBloomberg, M, Dugravot, A, Sommerlad, A, Kivimäki, M, Singh-Manoux, A, Sabia, S
JournalAge Ageing
Volume52
Issue2
Date Published2023 Feb 01
ISSN Number1468-2834
KeywordsAged, Cognition, Developing Countries, Educational Status, Female, Humans, Income, Male, Middle Aged, Sex Characteristics, United States
Abstract

BACKGROUND: The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries.

METHODS: Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education.

RESULTS: Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries.

CONCLUSION: Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.

DOI10.1093/ageing/afad019
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/36821646?dopt=Abstract

Alternate JournalAge Ageing
Citation Key13184
PubMed ID36821646
PubMed Central IDPMC9949595
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States
R01 AG018016 / AG / NIA NIH HHS / United States
R21 AG031372 / AG / NIA NIH HHS / United States
R01 AG037031 / AG / NIA NIH HHS / United States
R01 AG037031 / AG / NIA NIH HHS / United States
R01 AG056477 / AG / NIA NIH HHS / United States
RF1 AG062553 / AG / NIA NIH HHS / United States
MR/S011676/1 / MRC_ / Medical Research Council / United Kingdom