Food insecurity and gender inequalities in healthy ageing among older adults in India: Evidence from LASI Wave-I and Blinder-Oaxaca decomposition analysis

Background Population ageing has become a major public health challenge in India, prompting increased attention to factors that promote healthy ageing. Food insecurity is an important social determinant of health that may adversely affect physical, cognitive, psychological, and social well-being in later life. However, evidence on the association between food insecurity and healthy ageing among older adults in India remains limited. This study examined the relationship between food insecurity and healthy ageing, assessed gender differences, and quantified the contribution of socioeconomic factors to gender inequalities in healthy ageing among older adults in India. Methods This cross-sectional study utilized data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The analytical sample comprised 30,250 adults aged 60 years and above. Healthy ageing was assessed using a multidimensional Healthy Ageing Index (HAI) constructed from 28 indicators representing physiological health, functional ability, cognitive function, psychological well-being, and social engagement using principal component analysis. Food insecurity was measured using four items adapted from the Food Insecurity Experience Scale and categorized as food insecurity no” and food insecurity yes”. Descriptive statistics and independent-samples t -tests were used to compare HAI scores across population subgroups. Multivariable linear regression models, sex-stratified analyses, and interaction models were performed to examine the association between food insecurity and healthy ageing. Blinder-Oaxaca decomposition analysis was used to quantify the contribution of observed characteristics to gender differences in healthy ageing. All analyses accounted for the complex survey design and sampling weights. Results Overall, 45.3% of older adults experienced food insecurity. Food-insecure respondents had significantly lower healthy ageing scores than food-secure respondents (β = −0.98, 95% CI: −1.17 to − 0.78, p < .001). Women had significantly lower healthy ageing scores than men after adjustment for demographic and socioeconomic characteristics (β = −0.50, 95% CI: −0.75 to − 0.26, p < .001). The association between food insecurity and poorer healthy ageing remained significant in both men (β = −0.98, 95% CI: −1.25 to − 0.71, p < .001) and women (β = −0.95, 95% CI: −1.23 to − 0.68, p < .001). However, the interaction between food insecurity and sex was not statistically significant (β = 0.11, 95% CI: −0.26 to 0.49, p = .594), indicating that the association of food insecurity was comparable for both sexes. Blinder–Oaxaca decomposition showed that 80.93% of the observed gender gap in healthy ageing was explained by differences in observed characteristics, with work status and marital status contributing most to the explained component. Conclusions Food insecurity is independently associated with poorer healthy ageing among older adults in India, irrespective of sex. Older women experience lower healthy ageing than men, although the detrimental effect of food insecurity is similar for both sexes. Socioeconomic inequalities, particularly differences in employment history and marital status, explain a substantial proportion of the observed gender disparity in healthy ageing. Policies aimed at improving food security, strengthening social protection, and reducing gender-based socioeconomic inequalities may promote healthier ageing among India’s rapidly growing older population.