Abstract
Abstract Background Low‐and‐middle‐income countries (LMICs) face a crisis with a higher prevalence of dementia and cognitive impairment. It is projected that 68% of dementia cases worldwide will reside in LMICs in 2050. This differential risk is exacerbated by social and environmental determinants of health (SEDOH) and in settings with war, class division, and terrorism. There is no dementia research being conducted within these LMIC settings. Methods Data from three cross‐sectional fieldwork studies was used. In South Africa, 227 adults were from two wards of Thulani and Doornkop (11/11/19‐2/28/20). In Afghanistan, 478 adults were from 43 villages of Badakhshan and Ghazni provinces (2/15/22‐4/20/22). In Pakistan, 817 adults were from 43 villages of Punjab and Sindh provinces (4/22/22‐7/7/22). We examined the relationship between dementia and SEDOH via multidimensional poverty among adults ≥ 50 years of age adjusting for sex, marital status, age, and household size. Results In South Africa, Afghanistan, and Pakistan, respectively, men were more likely to be dementia‐free (32.1%, 60.8%, 65.49%) than women (24.7%, 32.5%, 34.51%). Across all countries, a higher proportion of older adults with moderate‐to‐severe dementia lived alone without a partner. In South Africa, Afghanistan, and Pakistan, adults with moderate‐to‐severe dementia were significantly more deprived of education, health status, and employment and were more often distressed, compared to adults without dementia in each country. The risk of dementia was higher for multidimensionally poor older adults. In South Africa, the odds of dementia were 2.31X (95%CI, 1.08‐4.95) for those who were multidimensionally poor. In Afghanistan, it was 10.2X higher (95% CI,1.97‐52.62) for poor adults ≥ 70 years. In Pakistan, there was a 5.02X higher risk (95% CI, 2.07‐12.16) for poor older adults at age ≥ 50 years. Conclusion The prevalence and depth of poverty were greater among older adults with dementia. A lack of education, poor health, and psychosocial distress are major dimensions of poverty associated with higher dementia risk. More importantly, dementia risk was significantly higher for women in all three countries compared to men. These findings support improvement in SEDOH through targeted structural policies, particularly for quality and free education and healthcare, to prevent dementia in later life.