Institutional contexts and cognitive health inequalities: an analysis of educational gradients and gender differences in cognitive health expectancy in Europe

Variations in the accumulation and decline of cognitive reserve across different cultural and institutional contexts, as well as selective survival processes that influence which population groups remain at risk for cognitive impairment, may contribute to the heterogeneity of educational disparities in cognitive health across European countries and between genders. We explore how educational disparities in Cognitive Health Expectancies (CHE) for men and women vary across different contextual settings in Europe, with a particular focus on Central and Eastern European (CEE) countries. Applying multivariate life table approach and the Sullivan methods to the Survey of Health, Ageing and Retirement in Europe (SHARE) data, we estimated CHE by gender and education at age 50 and the proportion of CHE relative to remaining life expectancy, across 10 European countries. We found that educational inequalities in cognitive health are significantly influenced by national context, with some of the most pronounced effects in CEE countries, particularly for women. Despite higher overall educational attainment in CEE countries, the benefits typically associated with education did not translate equally across groups. The key divergence, which is most pronounced for women, occurs among those with low educational attainment, who appear to be highly disadvantaged. Substantially smaller disparities, such as observed in Northern European countries, suggest untapped potential for mitigating educational inequalities in cognitive ageing.