Is Multidimensional Poverty Associated to Dementia risk? The case of Older Adults in Pakistan

Multidimensional poverty is associated with dementia. We aimed at establishing this association in Pakistan. A cross sectional study was conducted in Punjab and Sindh, Pakistan, between March 30th, 2002, and August 22nd, 2022, among adults aged 50 and older. Multidimensional poverty measures were composed of six dimensions and 15 indicators. Poverty was compared between adults with and without dementia using the Rowland Universal Dementia Assessment Scale, adjusting for sex, age, marital status, and household size. Associations between dementia and poverty were investigated using multivariate logistic regression model. We found that 594 (72.7%), 171 (20.9%), and 52 (6.4%) had no, mild, and moderate to severe dementia, respectively. More women than men had dementia (11.4% vs 2.9%). Approximately 40.4% adults with dementia were found to be deprived in four or more dimensions compared to 8.9% without dementia and the difference of multidimensional poverty between them was 348.6%. Education, health, living conditions and psychological well-being were main contributors to poverty. Poverty in four or more dimensions was strongly associated with dementia (odds ratio [OR], 5.02; 95%CI, 2.07-12.16) after adjusting for sex, marital status, age, and household size, with greater odds for older women (OR, 2.02; 95%CI, 1.41-2.90). Our findings suggest that early improvement in social determinants of health through targeted structural policies may prevent dementia later in life. Improving access to free, quality education, healthcare including mental healthcare and basic living standard, and to employment should reduce the collective risk of dementia.