Investigating Cross-National Variation in Later-Life Cognitive Health Inequalities

Lindsay Kobayashi
Assistant Professor, Department of Epidemiology, School of Public Health


By 2050, nearly 70% of global dementia cases are projected to occur in lower- and middle-income countries (LMICs). There is an urgent need to build up scientific evidence and resources to understand the etiology of cognitive aging outcomes in LMICs. A first step is to understand the measurement properties of various cognitive tests administered in these countries. This pilot project will use new data from five internationally harmonized longitudinal studies of aging using the Harmonized Cognitive Assessment Protocol (HCAP), including three LMICs and two high-income countries. Psychometric methods will be used to equate cognitive test item scores across countries so that cross-national comparisons may proceed.


  • Cho TC, Yu X, Gross AL, Zhang YS, Lee J, Langa KM, Kobayashi LC. Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. Lancet Healthy Longev. 2023;4(9):e461-e469. doi: 10.1016/S2666-7568(23)00113-7. PMCID: PMC10529910.
  • Kobayashi LC, Morris EP, Harling G, Farrell MT, Kabeto MU, Wagner RG, Berkman LF. Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014-2019. Journal of epidemiology and community health. 2022 April;76(4):385-390. PubMed PMID: 34556542; PubMed Central PMCID: PMC8919590; DOI: 10.1136/jech-2021-217059.
  • TC Cho, X Yu, AL Gross, YS Zhang, LC Kobayashi. Association of short-term wealth change with cognitive function among older adults in China, England, Mexico, and the United States, 2012-2018. Society for Epidemiologic Research Annual Meeting, June 14-17 2022.
  • Yu X, Zhang W, Kobayashi LC. Duration of subjective poverty in relation to subsequent cognitive performance and decline among adults aged ≥64 in China, 2005-2018. Soc Sci Med. 2021 Jun 30;283:114188. doi: 10.1016/j.socscimed.2021.114188. Epub ahead of print. PMID: 34225036.
  • National Institute on Aging. R01AG070953. Socioeconomic and Cardiovascular Sources of Cross-National Variation in Cognitive Health Among Older Adults. Role: PI
  • Kobayashi, L, Investigating Cross-National Variation in Later-Life Cognitive Health Inequalities. 4th Annual MiCDA Pilot Project Virtual Symposium. May 18, 2021.
  • Kobayashi LC, Gross AL, Gibbons LE, Tommet D, Sanders RE, Choi SE, Mukherjee S, Glymour MM, Manly JJ, Berkman LF, Crane PK, Mungas DM, Jones RN. You say tomato, I say radish: can brief cognitive assessments in the US Health Retirement Study be harmonized with its International Partner Studies? J Gerontol B Psychol Sci Soc Sci. 2020 Nov 29:gbaa205. doi: 10.1093/geronb/gbaa205. Epub ahead of print. PMID: 33249448.