Socioeconomic and clinical predictors of all-cause mortality among older adults in India from 2017 to 2024: the importance of cognitive health and dementia

BACKGROUND: Characterizing the correlates of adult mortality can lend insights into the factors associated with consequential health outcomes among older adults. In India, the importance of adult mortality has grown given trends in population aging, but prior research has been limited by a lack of high-quality longitudinal data. METHODS: We used new data from Waves 1 (2017-2019) and 2 (2022-2024) of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study (N = 3871) to evaluate associations between all-cause mortality and 27 socioeconomic and clinical factors using Cox proportional hazards models. We also evaluated gender differences and the impact of COVID-19. RESULTS: The estimated mortality rate was 6.0 (95% confidence intervals [95% CI]: 5.6-6.4) deaths per 100 person-years. A broad range of factors were associated with mortality, but cardiometabolic and cognitive phenotypes had some of the strongest -associations; those with dementia had a 2.84 (95% CI: 2.12-3.81) times greater risk of death than those with -normal -cognitive functioning. Associations with socioeconomic factors tended to be stronger for men than women (eg, wealth quintile; χ2 p = .046), whereas associations with clinical factors tended to be stronger for women than men (eg, diabetes; χ2 p = .033). We observed some evidence of excess mortality due to COVID-19. CONCLUSIONS: Findings emphasize the multifaceted nature of health among older adults in India and illustrate the need for solutions that recognize the importance of a wide range of social factors and clinical health conditions. Results also showcase the importance of dementia as a key factor associated with survival among older adults.