Assessing multilevel association of genderism on cognitive health of older adults across mesosystems and microsystems using the Longitudinal Aging Study of India: An adaptation of the ecological systems theory and cumulative disadvantage/advantage framework

Structural and social determinants across chronosystems critically shape educational transitions and cognitive aging in India by influencing cognitive reserve through life-course. Drawing on Bronfenbrenner’s Ecological Systems Theory and the Cumulative Disadvantage/Advantage frameworks, we conceptualize genderism as a structural determinant of cognitive health operating across multiple ecological levels - national (macrosystem), regional/states (mesosystem), and household/family or individual (microsystem) – within the India’s chronosystem. Using Wave 1 of the Longitudinal Ageing Study in India (2017–2018), we assessed cognitive health across five domains—memory, orientation, attention, object naming, and executive function—among older adults in 36 states and Union Territories. Three-level regression models examined how microsystem - individual (e.g., age, sex, education, childhood SES, widowhood, health behaviors), and household (MPCE, indoor air quality, urban/rural residence), and mesosystem state-level (women’s education and employment rates) factors interact to shape cognitive health outcomes. Cognitive health outcomes showed wide gender gaps with regional sex disparities with the largest gap among those with education less than primary education (men: 24; women: 20.7) which reversed among those with post-secondary education (women: 33; men: 32.7). Widowed women and those with poor health indicators had significantly lower cognitive health scores. At the microsystem household-level, urban residence (β = 2.64), and households with cleaner cooking fuel use (β = 1.61) and at the mesosystem state-level, the % of women with at least primary education (β = 1.82) and the % of women who were employed (β = 0.62) were associated with improved cognitive health outcomes. The findings reveal how genderism across chronosystems accumulate over life course highlighting the need for national-state-level policies that enhance women’s access to education, employment, health, and nutrition to mitigate gendered disparities in late life cognitive health of Indian adults. • Large subnational gender gaps in cognitive health; favor men in north and central Indian states. • Education is an equalizer: gaps are widest for below primary education, reverse at post-secondary. • Widowhood, rural residence, low-SES, early-life risks worsen women’s cognitive health. • State’s education/employment rates boost women’s cognitive resilience; need for gender-responsive, state-specific policies.