Regional Disparities in Educational Attainment and Its Impact on Cognitive Health in Western and Eastern Africa

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BACKGROUND: Education is a crucial social determinant of health, influencing opportunities, socioeconomic status, and health outcomes. Regional disparities in educational attainment and their effects on cognitive health are especially notable in low- and middle-income countries (LMICs), where access to education and healthcare varies widely. This study explores the role of education in health disparities, focusing on two distinct African regions-Western and Eastern Africa-using data from the READD-ADSP DAWN Study. METHOD: This cross-sectional study analyzed data from Western Africa (n = 756) and Eastern Africa (n = 689). Variables included early-life learning disability, special education participation, educational attainment (None, Elementary, High School, College, Graduate/Professional), and cognitive health diagnoses (Non-Cognitively Impaired, MCI, AD, Dementia, Other or No Diagnosis). A Wilcoxon rank sum test assessed differences in educational attainment between cognitive diagnostic groups. Logistic regression with a logit link function examined the relationship between years of education and the likelihood of a primary diagnosis of Alzheimer's Disease or Dementia. RESULT: In the Eastern region sample, the Wilcoxon rank sum test revealed a significant difference in education levels between individuals with and without a cognitive health diagnosis (W=68233, p <0.001). Logistic regression showed that education was a significant predictor of diagnosis (β=-0.04891, SE=0.01641, z=-2.980, p = 0.00288). Higher education levels were associated with lower odds of a cognitive health diagnosis. The model fit was reasonable, with a residual deviance of 927.65 and an AIC of 931.65. In the Western region sample, the Wilcoxon rank sum test also showed a significant difference in education levels between individuals with and without a cognitive health diagnosis (W=81364, p = 0.02669). Logistic regression confirmed that years of education significantly predicted diagnosis status (β=-0.02640, SE=0.01076, z=-2.454, p = 0.0141), with higher education linked to lower odds of being diagnosed with a cognitive health diagnosis. The model fit was adequate, with a residual deviance of 1060.2 and an AIC of 1064.2. CONCLUSION: These findings further support the protective role of education against cognitive decline in both regions.