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Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017-2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%-46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%-56.5%) had been diagnosed, 38.9% (95% CI 38.1%-39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%-32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14-1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61-0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68-1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86-1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00-1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10-1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017-2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.

IntroductionAlzheimer’s disease and related dementias can be considered the epidemic of the 21st century. Particularly, the predicted growth in the size of elderly populations in low-income and middle-income countries is expected to produce a dramatic surge in dementia prevalence and incidence. Although a rising burden of dementia presents an urgent challenge for India, previous efforts to study dementia in the country have relied on non-representative samples in geographically restricted regions. The Harmonised Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) will provide rich, population-representative data on late-life cognition and dementia and their risk factors for the first time in India.MethodsThe LASI-DAD will recruit a sample of 3000 people aged 60+ years. Their family members or friends, whom respondents nominate as informants, participate in the computer-assisted personal interview. The study sample is drawn from the ongoing, nationally representative Longitudinal Aging Study in India, a multipurpose panel survey of aging. We aim to collect rich data on cognitive and neuropsychological tests, informant reports, and epidemiological data through a comprehensive geriatric assessment, and venous blood collection and assays. For a subsample, we collect neuroimaging data. Data collection is currently in progress in 14 States and Union Territories of India. Clinicians will provide clinical consensus diagnosis based on the Clinical Dementia Rating.Ethics and disseminationEthics approval was obtained from the Indian Council of Medical Research and all collaborating institutions. Anonymised data will be available for the larger research community through a secured website hosted by the Gateway to Global Aging Data platform. Research findings from the LASI-DAD team will be disseminated through journal publications and presentations at professional conferences.

In social environments characterized by high levels of gender inequality, women fare worse than men in human capital accumulation and health. We examine the association of gender inequality with female disadvantage in late-life cognitive function, using newly available data from Wave 1 (2017–2019) of the Longitudinal Aging Study in India (LASI), representative of the Indian population over the age of 45. We find a substantial female gap in cognition among mid-aged and older adults in India; early life socioeconomic conditions and education explain up to 74 percent of the female disadvantage in cognition, and model predictions suggest that it takes nine years of education on average to overcome this deficit. However, further contextualizing the environment, we find that the level of education at which differences in late-life cognition between women and men become negligible increases with the degree of gender inequality.

Despite its high disease burden, few existing estimates of the prevalence of obstructive lung disease in India are based on high-quality data sources. To our knowledge, prior studies at the national level have not included objective measurements of lung function. The Longitudinal Aging Study in India administered spirometry to adults 45 years and older (N = 31,103). We estimated inverse probability weights to account for sample selection processes and quantified the prevalence of obstructive lung disease overall and by region, age, and gender. We investigated the overlap among objective rates of obstructive lung disease, respiratory symptoms, and self-reported diagnoses. Additionally, we evaluated associations between obstructive lung disease and pertinent risk factors. The overall prevalence of obstructive lung disease was 14.4% (95% confidence interval [CI] 13.4–15.4). Prevalence was higher among men than women (p < 0.001) and increased with age (p < 0.001). Disease awareness was low, with only 12.0% (95% CI 9.9–14.5) of men and 11.0% (95% CI 8.6–14.0) of women with obstructive lung disease reporting prior diagnoses of lung disease. We observed heterogeneity by region (p < 0.001), which largely remained after accounting for differences in demographic and risk factors. High prevalence and low disease awareness highlight important challenges in the prevention and management of obstructive lung disease in India. Multifaceted approaches are needed to address this disease burden, including understanding and lowering exposure to risk factors and improving infrastructure and resources for diagnosing and managing obstructive lung disease.

The Great East Japan Earthquake of March 2011 and it's massive tidal waves wreaked devastating damage on residences and communities along 400 km of the Pacific coast in Japan. Using the panel data from the Japanese Study of Aging and Retirement, we estimate the effects of this disaster on individual health, finding a significant negative impact on the health of those in the area. In addition, we exploit a discontinuous decrease in copayments for medical care at the age of 70 years and find that the reduction in copayment increased medical and long-term care utilization and significantly reduced health deterioration after the earthquake.

The prevalence of dementia is on the rise, with 60% of dementia cases existing in low- and middle-income countries. In India, the prevalence was reported to be 7.4%. Since the pathophysiology of dementia is multifactorial, the Harmonized Longitudinal Aging Study in India for the Diagnostic Assessment of Dementia (LASI-DAD) collected data to capture multiple domains, including venous blood specimens (VBS). VBS collection and assays help ascertain the overall health status of an individual, understand disease pathogenesis, and diagnose diseases. In community settings, blood assays also help identify disease trends. However, community VBS collections can often be challenging. Sample quality can be impaired due to individual, environmental, geographical, and pre-analytical processing factors. Therefore, standardization of the process is imperative to ensure biomarker data of high accuracy. LASI-DAD developed a systematic sample collection, shipment, processing, and storage protocol. Multiple checkpoints were in place to monitor sample quality in real time. A phlebotomist was trained from each participating state for specimen collection. All samples were centrally tested for analytes. The overall response rate for blood collection was 71.5%. We collected 17 mL of VBS from 3,252 respondents, who consented to participate. Blood samples were tested for routine analytes, and those specific to Alzheimer’s Disease (AD) and AD-related dementias (ADRD). Data was reviewed fortnightly. The median cold chain temperature was 6.2°C and hemolysis was seen in 6.7% of the samples. LASI-DAD standardized and implemented VBS collection while overcoming the challenges faced due to India’s diverse socio-demographic, geographical, and environmental conditions. This methodology can serve as a robust tool for VBS handling and ensuring high sample quality for future community-based studies.

India, with its rapidly aging population, faces an alarming burden of dementia. We implemented DSM-5 criteria in large-scale, nationally representative survey data in India to characterize the prevalence of mild and major Neurocognitive disorder. The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) (N = 4,096) is a nationally representative cohort study in India using multistage area probability sampling methods. Using neuropsychological testing and informant reports, we defined DSM-5 mild and major neurocognitive disorder, reported its prevalence, and evaluated criterion and construct validity of the algorithm using clinician-adjudicated Clinical Dementia Ratings (CDR)®. The prevalence of mild and major neurocognitive disorder, weighted to the population, is 17.6% and 7.2%. Demographic gradients with respect to age and education conform to hypothesized patterns. Among N = 2,390 participants with a clinician-adjudicated CDR, CDR ratings and DSM-5 classification agreed for N = 2,139 (89.5%) participants. The prevalence of dementia in India is higher than previously recognized. These findings, coupled with a growing number of older adults in the coming decades in India, have important implications for society, public health, and families. We are aware of no previous Indian population-representative estimates of mild cognitive impairment, a group which will be increasingly important in coming years to identify for potential therapeutic treatment.

Background The aim of this study was to investigate whether anemia is associated with dementia incidence in the elderly. Methods Using the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, we identified 66-year-old subjects ( n  = 37,900) who were free of dementia and stroke. Anemia (hemoglobin < 12 g/dl for women and < 13 g/dl for men) and the severity of anemia (mild, moderate, or severe) were defined using World Health Organization criteria. The incidence of dementia was identified using International Classification of Diseases, Tenth Revision, dementia diagnosis codes (F00, F01, F02, F03, and G30) with prescription of an antidementia drug. Cox proportional hazards regression models were used to assess HRs for dementia incidence according to anemia. Results After adjusting for sex, baseline cognitive state, body mass index, smoking status, household income, disability, depression, hypertension, diabetes, and dyslipidemia, we found a significant association between anemia and dementia incidence (adjusted HR 1.24; 95% CI 1.02–1.51). The adjusted HRs for incidence of dementia according to the severity of anemia were 1.19 (95% CI 0.98–1.45) for those with mild anemia, 1.47 (95% CI 0.97–2.21) for those with moderate anemia, and 5.72 (95% CI 1.84–17.81) for those with severe anemia, showing a significant p value for trend ( p  = 0.003). Conclusions Anemia is an independent risk factor for dementia incidence, with a marked increase of risk associated with severe anemia.

Rapid demographic transition in East Asia has resulted in “super” aging. Because of steadily decreasing fertility and increasing life expectancy, the proportion of older individuals in the population and the old-age dependency ratio are rising across all East Asian countries, particularly China, the Republic of Korea, and Japan. This study empirically investigated the well-being of older individuals in these three countries using comparable micro-level data from the China Health and Retirement Longitudinal Study, Korean Longitudinal Study on Aging, and Japanese Study of Aging and Retirement. Specifically, we examined the depressive symptoms scale as a measure of well-being and estimated the impact of four broad categories: demographic; economic; family-social; and health. The decomposition-and-simulation analyses reveal that although differences in the characteristics of older individuals in the three countries among countries explain many differences in mean depression rates, there remain significant differences across countries, which cannot be explained. Even after considering multiple factors, the study found that older individuals in Korea were more likely to be depressed than those in China or Japan.

This study aimed to determine the dose–response relationship between the levels of statin exposure and the incidence of Alzheimer’s disease (AD). We included 119,013 Korean adults (≥ 60 years old) using a database from the Korean National Health Insurance Service (2002–2013). Statin exposure was treated as a time-varying variable. Incidence of AD was defined by the first claim code for AD with anti-Alzheimer drugs. AD occurred in 9467 cases during a median 7.2 years of follow-up. Overall, statin use was not associated with an increased risk of AD incidence [adjusted hazard ratio (aHR) = 1.04; 95% confidence interval (CI) = 0.99–1.10]. When examined by level of statin exposure, statin prescription < 540 days during a 2-year window time was associated with a higher risk for incidence of AD compared to statin non-use. However, days of prescription ≥ 540 and cumulative defined daily dose ≥ 540 of statin were associated with decreased risk of AD [aHR (95% CI) = 0.87 (0.80–0.95) and 0.79 (0.68–0.92), respectively]. Our findings indicate that less persistent statin use is associated with increased risk of AD, whereas persistent and adherent statin use is associated with decreased risk of AD.