Focus on housing issues: Associations between housing quality and cognitive impairment among older adults in China and India

Background Housing is a key social determinant of health, yet its association with cognitive impairment, a precursor to dementia and Alzheimer's disease, remains understudied in rapidly aging populations. Objective To investigate the association between housing quality and cognitive impairment among community-dwelling older adults in China and India. Methods This study examined the association between housing quality and cognitive impairment in community-dwelling older adults using nationally representative data from the China Health and Retirement Longitudinal Study (n = 5136) and the Longitudinal Ageing Study in India (n = 29,124). Housing quality was assessed using five indicators (temporary housing materials, sanitation, tap water access, solid fuel use for cooking, and electricity) and categorized as good (0–1 scores), moderate (2–3 scores), or poor (4–5 scores). Cognitive function was assessed using validated instruments adapted for each dataset, with cognitive impairment defined as performance at least one standard deviation below age-specific norms. Results The median age was 67 years in India and 66 years in China, with 51.41% and 44.31% female participants, respectively. A significant dose-response relationship was observed between housing quality and cognitive impairment in both countries. Compared with good housing quality, moderate housing quality was associated with 1.54 (95% CI: 1.41–1.68) and 1.41 (95% CI: 1.16–1.72) times higher odds of cognitive impairment in India and China, respectively, while poor housing quality was associated with 1.94 (95% CI: 1.75–2.16) and 1.97 (95% CI: 1.56–2.50) times higher odds, respectively, after adjustment for confounders. Conclusions Housing quality is a potentially modifiable environmental determinant of cognitive impairment in aging populations.