Consanguineous marriage and associated diseases among their children and grandchildren in India: evidence from large-scale data.

Worldwide, more than 130 million infants are born each year and a considerable number of 13.5 million of these children have inbred parents. The present study aimed to investigate the association between parents' consanguinity and chronic illness among their children and grandchildren in India. The nationally representative data, Longitudinal Aging Study in India, 2017-2018, Wave 1 was used for the present study. Bivariate analysis, a probit model, and propensity score estimation were employed to conduct the study. The study observed the highest prevalence of consanguinity marriage in the state of Andhra Pradesh (28%) and the lowest in Kerala (5%) among the south Indian States. People who lived in rural areas, belonged to the richer wealth quintile and Hindu religion were the significant predictors of consanguinity marriage in India. For individuals who were in consanguineous marriages, there was 0.85%, 0.84%, 1.57% 0.43%, 0.34%, and 0.14% chances of their children and grandchildren developing psychotic disorders, heart disease, hypertension stroke, cancer, and diabetes, respectively. Moreover, around 4.55% of the individuals have a history of birth defects or congenital disorders. To address the risk of complicated illnesses due to the consanguinity of marriage, medical, genetic, and social counselling services are required.

Drivers of perceived discrimination among older adults in India: an intersectional analysis.

Discrimination is harmful action taken against individuals or groups to protect customary relations of power and privilege. Older adults are particularly vulnerable to experiences of discrimination that adversely affect their quality of life. We use data from the Longitudinal Ageing Study of India (LASI; Wave 1; 2017-2018) to examine different contextual forces that shape the experiences of discrimination in older adults in India, specifically gender, caste, and economic condition. We used the theory of intersectionality to hypothesize that economic condition, caste, and gender combine uniquely to engender perceived discrimination in older adults. We first used a concentration index to determine the sample's pre-existing inequality levels. The concentration curve evidenced a disproportionate concentration of discrimination among people with low income. Next, we used a three-way ANCOVA to examine the effects of caste, gender, and economic condition on individuals' experiences of discrimination. A significant interaction effect of caste, gender, and economic condition [F(1, 30,394) = 8.91 p = 0.003] evidenced the compounding effects of inequalities on experiences of discrimination. Finally, we ran a moderation model to test the ameliorating effects of education on experiences of discrimination experienced by marginalized castes. The model was significant (ß= -0.192; p < 0.001), thereby supporting the proposition that increased education level can lead to an increased sense of belonging and perceptions of equal treatment, which relate negatively to perceived discrimination. Results are discussed considering intersectionality in peoples' struggles and resilience in India.

Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on National Family Health Survey, 2019-2021.

Due to ovarian insufficiency, some women attain menopause at an early age due to lifestyle factors and hormonal imbalances. Menopause occurring before the age of 40 is premature and between 40 and 44 years age is early, since the natural age of menopause lies between 45 and 50. The study estimated the prevalence of both premature and early menopause, and examined the potential associated factors that could trigger its occurrence in India. The National Family Health Survey, conducted during 2019-2021, was used to fulfil the study objective. The study sample was divided into two parts, with age group 15-39 and 40-44 for estimating premature and early menopause, respectively. Cox-proportional hazard model was used for the multivariate analysis. The estimated prevalence of premature menopause is 2.2% and early menopause is 16.2%. Lower educational level, poor economic condition, smoking, fried food consumption, early age at menarche are some of the significant explanatory factors. In India, both the proportion and the absolute number of post-menopausal women are growing, therefore it is critical to revamp public reproductive healthcare facilities to include menopausal health segment in women's health as well. Future detailed micro-studies would help in better understanding of the premature or early menopausal cases.

Indoor air pollution and cognitive function among older adults in India: a multiple mediation approach through depression and sleep disorders.

BACKGROUND: Studies across multiple countries reveal that depression and sleep disorders can lead to cognitive decline. This study aims to speculate on the effect of different sources of indoor air pollution on cognition and to explore the mediation effect of depression and sleep disorders on cognition when exposed to indoor air pollution. We hypothesize that an older adult experiences higher cognitive decline from indoor pollution when mediated by depression and sleep disorders. METHODS: We use data from Longitudinal Aging Study in India (LASI), 2017-2018, and employ a multiple mediation model to understand the relationship between indoor air pollution and cognition through sleep disorders and depression while adjusting for possible confounders. Sensitivity analysis was applied to see the effect of different sources of indoor pollution (cooking fuel, indoor smoke products, and secondhand smoke) on cognitive performance. RESULTS: The effect of three sources of indoor pollutants on cognition increased when combined, indicating stronger cognitive decline. Unclean cooking practices, indoor smoke (from incense sticks and mosquito coils), and secondhand smoke were strongly associated with sleep disorders and depression among older adults. Indoor air pollution was negatively associated with cognitive health (ß= -0.38) while positively associated with depression (ß= 0.18) and sleep disorders (ß= 0.038) acting as mediators. Sensitivity analysis explained 45% variability while adjusting for confounders. CONCLUSION: The study lays a foundation for future investigations into the nexus of indoor pollution and mental health. It is essential to formulate policies to reduce exposure to varying sources of indoor air pollutants and improve screening for mental health services as a public health priority.

District-level heterogeneity in overweight or obesity among women of reproductive age: A geo-spatial analysis in India.

BACKGROUND: Globally by 2030, 38% of the world's population would be overweight, and another 20% would be obese. This has led to rising concerns regarding how swiftly and substantially the world is moving towards this epidemic of "globesity". India too is facing an increased burden of overweight and obese population. The changing dietary patterns are significantly associated with the increasing prevalence of overweight/obesity and related complications, especially among women. Hence, the present study aims to observe the spatial patterns of overweight or obesity among women in reproductive age group in India and factors associated with it. METHODS: The study analyzed data from a cross-sectional nationwide household survey, i.e. National Family Health Survey (NFHS-4), 2015-16. The primary outcome variable of this study was overweight/obesity among reproductive-age women, which was measured through the body mass index (BMI) of the women. Bivariate and multivariate logistic regression analysis was used to analyze the data. Additionally, for spatial analysis in terms of overweight/obesity among women in India, univariate and bivariate Moran's I index measurements were used along with the usage of spatial regression models. RESULTS: The value of spatial-autocorrelation for overweight or obese was 0.64, which depicts the moderately high prevalence of the overweight/obesity coverage over districts of India. The overall prevalence overweight/obesity among women in India is around 25% and higher proportion of women from urban areas (37.8%), and non-poor (33.4%) economic group reported to be overweight or obese. From spatial lag model, the lag coefficient was found to be 0.28, implying that a change in the prevalence of overweight/obesity among women in a certain district may statistically lag the prevalence of overweight/obesity by 28% in the neighbouring districts. There were significantly high clustering of overweight/obese women and non-poor wealth quintiles in 132 districts, mainly from states of Punjab, Haryana, Gujarat, Maharashtra, Kerala, Tamil Nadu, Karnataka and Andhra Pradesh. Additionally, there was high-high clustering of overweight/obese women and those who ever had caesarean in 82 districts, mostly from Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. CONCLUSION: The spatial patterns on the prevalence of overweight and obesity in India show that the women belonging to the southern states' districts are more overweight or obese in comparison to other states. The determinants like older age, higher education, urban residence, higher economic status are the key factors contributing to the prevalence of overweight or obesity among women in the reproductive age group. The study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status, to reduce the risks of health consequences due to overweight and obesity.

Linkage of premature and early menopause with psychosocial well-being: a moderated multiple mediation approach.

PURPOSE: Menopause occurring before the age of 40 is premature and between 40 and 44 years age is early, since the natural age of menopause lies between 45 and 50. The endocrine changes that come with menopause include an erratic decline in estrogen levels which affects the brain. Thus, leading to changes in cognitive function in the longer term due to the menopausal transition. The study aims to explore the effect of premature and early menopause on cognitive health, and psychosocial well-being. The moderated multiple mediation hypothesis of the study is that the effect of premature or early menopause is mediated by depression and insomnia, while all the pathways are moderated by smoking habits. DATA AND METHODS: The study utilized Longitudinal Aging Study in India (LASI), 2017-2018, Wave 1 data. The sample of 31,435 women were aged 45 and above and did not undergo hysterectomy. A moderated multiple mediation model was used to understand the association between premature or early menopause (X), insomnia (M1), depression (M2), moderator (W), and cognitive health (Y), while controlling for possible confounders. RESULTS: Premature menopause was negatively associated with cognition (ß:-0.33; SE:0.12; p < 0.05), whereas positively associated with insomnia (ß:0.18; SE:0.03; p < 0.001) and depression (ß:0.25; SE:0.04; p < 0.001). There is a moderating effect of smoking or tobacco consumption has a significant moderating effect on the pathways among premature menopause, depression, insomnia and cognition. When the same model was carried out for early menopause (40-44 years), the results were not significant. CONCLUSIONS: The findings emphasize the fact that smoking is associated with premature menopause, depression and insomnia. Women who experienced premature menopause has lower cognitive scores, depressive symptoms and insomnia symptoms, which were higher among those who consumed tobacco. The study, strongly recommends the dissemination of information on the negative effects of tobacco consumption and making more informed choices to maintain a healthy life. More research into various methods and therapy is needed to determine the relationship between the age of early menopause and their psychosocial well-being.

Surging trends of infertility and its behavioural determinants in India.

The World Health Organisation (WHO) has recognised infertility as a public health issue. Although biological factors are considered to be the primary cause, factors like social, health, and lifestyle factors can all have an adverse effect on a couple's ability to reproduce. The study aimed to comprehend the infertility scenario in India and explore some of the potential causes. The study used standard demographic definitions and four rounds of the National Family Health Survey (NFHS) from 1992-1993 to 2015-16 to estimate the levels of primary and secondary infertility in India. Bivariate analysis, the t-test, and the Chi-square test were applied to capture significant changes in infertility over time. The multivariate logistic regression model was used to understand the extent of infertility among Indian couples from various socioeconomic groups, lifestyle levels, and reproductive behaviour in 2015-16. Primary infertility declined steadily from 1992 to 2015, whereas secondary infertility increased from 19.5% in 1992-93 to 28.6% in 2015-16. This trend is related to declining fertility rates, particularly in India's southern states. Age at marriage, biological factors, and lifestyle factors were all strongly linked to infertility. People with higher education levels and late marriages were more likely to experience primary infertility. Alcohol consumption, smoking, obesity, and noncommunicable disease are all strongly linked to secondary infertility. Our study has policy implications, and we draw attention to alarming infertility in India, which has gone unnoticed due to large population. We suggests enhancing the current health and reproductive programmes, educating people about improving their lifestyle choices and sexual behaviour, and calling attention to a significant shift in fertility dynamics.

Rural-urban difference in meeting the need for healthcare and food among older adults: evidence from India.

BACKGROUND: Due to changes in demographic and epidemiological scenarios, and the gradual increase in the older population, India is yet to prepare for rising nutrition and health-related issues among older adults in the coming decades. While the process of ageing and its associated aspect has been found to have an urban-rural divide. Thus, this study examines rural/urban differences in unmet needs for food and healthcare among Indian older adults. METHODS: A sample of 31,464 older adults aged 60 years and above were considered in the study from the Longitudinal and Ageing Survey of India (LASI). The bivariate analysis was done using the sampling weights. Logistic regression and decomposition analysis was used to explain the rural-urban gap in the unmet needs for food and healthcare among Indian older adults. RESULTS: Rural older adults were more vulnerable to meeting the need for health and food than their urban counterparts. While factors that contributed majorly to the difference in unmet need for food between urban and rural were education (34.98%), social group (6.58%), living arrangements (3.34%) and monthly per capita expenditure (MPCE) (2.84%). Similarly, for the unmet need for health, the factors that contributed the most to the rural-urban gap are education (28.2%), household size (2.32%), and MPCE (1.27%). CONCLUSION: The study indicates more vulnerability among rural older adults than compared to urban older individuals. The targeted policy-level efforts should be initiated considering the economic and residential vulnerability identified in the study. There is a need for primary care services that can provide targeted help to older adults in rural communities.

An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India.

Life satisfaction refers to the assessment of one's own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017-18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults' physical, social, and mental health for the betterment of healthy ageing.

Study on depletion of ovarian function and late-life chronic diseases in India.

OBJECTIVE: The current study aims to understand premature and early menopausal age in association with chronic conditions. METHODS: The present cross-sectional study analyzed nationally representative data from LASI (Longitudinal Aging Study in India) from 2017 to 2018. Bivariate analysis including cross-tabulation and χ2 tests were performed. Further multiple regression analysis was performed, using the generalized linear model of logit link. RESULTS: Approximately 2533 (8%) older women reported that they had experienced premature menopause (before age 40), while 3889 (12.4%) reported having early menopause (age 40-44). The likelihood of a woman with premature menopause developing cardiovascular diseases (CVDs) is 15% higher (adjusted odds ratio [AOR], 1.15; P < 0.05) than those who do not experience premature menopause, while women with early menopause have a 13% higher risk (AOR, 1.13; P < 0.05). For women who experienced premature menopause and were also smokers, the probability of developing CVDs was higher. Other chronic diseases such as bone or joint problems, diabetes, and eye vision problems were also shown to be significant health problems among women who had premature ovarian failure. CONCLUSION: Our results show significant association between women with premature or early depletion of ovarian function and chronic health conditions such as cardiovascular diseases, bone or joint problems, vision problems, and neurological or psychiatric disorders at their later life ages. Comprehensive strategies in the form of lifestyle changes may regulate hormonal levels and allow the body to reach menopause at the appropriate age.

Inequalities and Effect of Non-Biological Factors on Perinatal Mortality in Uttar Pradesh.

Approximately 6 million neonatal deaths occur globally, with approximately 99 percent of them occurring in developing countries. This study is an attempt to examine the prevalence and influence of non-biological factors on perinatal mortality in India. National Family Health Survey (2015-2016) data and bivariate and multivariate techniques have been used to fulfill the aforesaid objectives. Findings suggest that approximately 47 perinatal deaths occurred per 1,000 pregnancies lasting seven or more months during the last five years preceding the survey in Uttar Pradesh. Parental education, wealth status, variables related to pregnancy and delivery, mother's demographic factors, mother's height, and child characteristics have shown significant impact on perinatal mortality. For a policy point of view, more emphasis is needed on quality of care of National Health Mission (NHM) strategy at times of greater risk-that is, birth and the first few days of life-which could be the way forward for reducing high perinatal deaths.

Spatial shifting of COVID-19 clusters and disease association with environmental parameters in India: A time series analysis.

BACKGROUND: The viability and virulence of COVID-19 are complex in nature. Although the relationship between environmental parameters and COVID-19 is well studied across the globe, in India, such studies are limited. This research aims to explore long-term exposure to weather conditions and the role of air pollution on the infection spread and mortality due to COVID-19 in India. METHOD: District-level COVID-19 data from April 26, 2020 to July 10, 2021 was used for the study. Environmental determinants such as land surface temperature, relative humidity (RH), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), Ozone (O3), and Aerosol Optical Depth (AOD) were considered for analysis. The bivariate spatial association was used to explore the spatial relationship between Case Fatality Rate (CFR) and these environmental factors. Further, the Bayesian multivariate linear regression model was applied to observe the association between environmental factors and the CFR of COVID-19. RESULTS: Spatial shifting of COVID-19 cases from Western to Southern and then Eastern parts of India were well observed. The infection rate was highly concentrated in most of the Western and Southern regions of India, while the CFR shows more concentration in Northern India along with Maharashtra. Four main spatial clusters of infection were recognized during the study period. The time-series analysis indicates significantly more CFR with higher AOD, O3, and NO2 in India. CONCLUSIONS: COVID-19 is highly associated with environmental parameters and air pollution in India. The study provides evidence to warrant consideration of environmental parameters in health models to mediate potential solutions. Cleaner air is a must to mitigate COVID-19.

Age, gender and socioeconomic patterns of awareness and usage of e-cigarettes across selected WHO region countries: evidence from the Global Adult Tobacco Survey.

OBJECTIVES: The study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries. DESIGN: Cross-sectional. SETTING: 14 countries. PARTICIPANTS: Surveyed population ≥15 years selected through multi-stage cluster sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: We selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017. RESULTS: Awareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia . CONCLUSIONS: E-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.

Applications of new measures of population ageing using quantity and quality of remaining life years to India and selected states.

In the latter part of the third stage, India is in demographic transition with declining fertility and mortality. This marked decline in death rates is driven by improvements in health conditions due to medical progress and better living conditions. The conventional measures of ageing do not account for the significant improvements in health and life expectancy, thus leading to a tendency to overestimate the impact of population ageing when these indicators are used. The old-age threshold in the conventional measures of ageing depends on chronological age. The present study estimated the multi-dimensional old-age thresholds (MOAT) based on the remaining life expectancy (RLE), self-rated health, activities of daily living (ADL), handgrip strength, and cognition in India and selected states. The standard population was derived for each dimension for 50 and over in states using the WHO Study on Global AGEing and Adult Health data. Keeping the dimensional characteristics as of the standard population, the estimated MOAT for India was 67 years where Maharashtra stands at the top (68.6), followed by, West Bengal (66.5) and Karnataka (66). A 64 year old woman was similar to 68.8 year old man, and a 66 year old rural person was equivalent to 68 year old urban person. The study suggests implications of MOATs on reducing the burden of ageing and increment in retirement age.

District Level Geospatial Analysis of Utilization of ICDS Services Among Children in India.

Introduction: Integrated Child Developmental Services (ICDS) is the most extensive government-run health program for children with its foot spread across the complete Indian Territory. ICDS Scheme, has been provided for 40 years and has been successful in some ways. The program in reducing the undernourishment among children over the past decade has been modest and slow in India than what has been reached in other countries with comparable socio-economic measure. Therefore, this study aims to identify the district level clustering of the utilization of ICDS services in India, and the present research also tried to relate it with socio-economic and demographic factors. Materials and Methods: The data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16 in India is used to carry out the analysis. We classified the country in 640 districts and employed geospatial techniques like Moran's I, univariate and bivariate local indicators of spatial association (LISA), and spatial error regression. Results: The non-utilization under ICDS scheme varied between 93% in West Siang district of Arunachal Pradesh and around 7% in the Kandhamal district of Odisha in 2015-16 in India. The univariate LISA results suggest striking geographic clustering of utilization of ICDS services among children in India (Moran's I: 0.612). On another hand, there were regions with substantially low-low clustering of non-utilization of ICDS services in southeast India, including districts in Andhra Pradesh, Chhattisgarh, Southern Madhya Pradesh, Odisha, Telangana, and West Bengal. The findings also suggest that the proportion of the rural population (-0.190), and poor households (-0.132) in the district were significantly and negatively related while the proportion of uneducated women (0.450) was positively related to the non-utilization of ICDS services within the district. Conclusion: This is the first-ever study that examined the complex interplay of the rural population, female illiteracy, poverty, SC/ST population, and Hindu population with non-utilization of ICDS services among children in the district in India. The study highlights the inter-district geographical disparities in the non-utilization of ICDS services. Further, it confirms that underprivileged districts in terms of the rural population and poor households are also disadvantageous in the utilization of ICDS services.

Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015-16).

BACKGROUND: In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes. METHODS: The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015-16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities. RESULTS: Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53-1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61-6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17-1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36). CONCLUSION: The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.

An analytical pathway of consumption expenditure with neighborhood deprivation and depression on cognitive health among elderly in India: A moderated mediation approach.

BACKGROUND: This study aims to find the linkage between neighborhood deprivation and cognition with depression as a mediating factor while economic condition as a moderator. METHODS: We have used the recent baseline wave-1 data of Longitudinal Aging Study in India (LASI), 2017-2018. The study was restricted to 60 and above population, consisting of males (14,931) and females (16,533). We have used moderated mediating model to understand the relationship between deprivation (X), cognition (Y) mediated through depression (M), moderated by economic condition (W), while controlling all possible confounders. RESULTS: Neighborhood deprivation was positively associated with depression (ß: 0.12; SE: 0.01) and inversely linked to cognition (ß: -0.4; SE: 0.02). Deprivation had a strong indirect effect on cognition that was mediated by depression. Further, interaction of depression (M) and economic condition (W) was negatively associated (ß = -0.03; SE: 0.01) with cognition (Y), indicating that lower economic section being more depressed with lower cognitive function. LIMITATIONS: The study failed to capture other mental health aspects like stress and anxiety using the Depression, Anxiety and Stress Scale-21 items (DASS-21). CONCLUSIONS: This study has found a link between higher economic condition with low deprivation and depression. Older individuals with better financial situation have improved cognitive level than their counterparts, who are also depressed. This study provides an opportunity to conduct future research on cognitive health in the face of population aging in India.

Survival Analysis of Patients With COVID-19 in India by Demographic Factors: Quantitative Study.

BACKGROUND: Studies of the transmission dynamics of COVID-19 have depicted the rate, patterns, and predictions of cases of this pandemic disease. To combat transmission of the disease in India, the government declared a lockdown on March 25, 2020. Even after this strict lockdown was enacted nationwide, the number of COVID-19 cases increased and surpassed 450,000. A positive point to note is that the number of recovered cases began to slowly exceed that of active cases. The survival of patients, taking death as the event that varies by age group and sex, is noteworthy. OBJECTIVE: The aim of this study was to conduct a survival analysis to establish the variability in survivorship of patients with COVID-19 in India by age group and sex at different levels, that is, the national, state, and district levels. METHODS: The study period was taken from the date of the first reported case of COVID-19 in India, which was January 30, 2020, up to June 30, 2020. Due to the amount of underreported data and removal of missing columns, a total sample of 26,815 patients was considered. Kaplan-Meier survival estimation, the Cox proportional hazard model, and the multilevel survival model were used to perform the survival analysis. RESULTS: The Kaplan-Meier survival function showed that the probability of survival of patients with COVID-19 declined during the study period of 5 months, which was supplemented by the log rank test (P<.001) and Wilcoxon test (P<.001) to compare the survival functions. Significant variability was observed in the age groups, as evident from all the survival estimates; with increasing age, the risk of dying of COVID-19 increased. The Cox proportional hazard model reiterated that male patients with COVID-19 had a 1.14 times higher risk of dying than female patients (hazard ratio 1.14; SE 0.11; 95% CI 0.93-1.38). Western and Central India showed decreasing survival rates in the framed time period, while Eastern, North Eastern, and Southern India showed slightly better results in terms of survival. CONCLUSIONS: This study depicts a grave scenario of decreasing survival rates in various regions of India and shows variability in these rates by age and sex. In essence, we can safely conclude that the critical appraisal of the survival rate and thorough analysis of patient data in this study equipped us to identify risk groups and perform comparative studies of various segments in India. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1101/2020.08.01.20162115.