Current and long-term spousal caregiving and onset of cardiovascular disease
- 1Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
- 2Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- 3Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
- Correspondence to Benjamin D Capistrant, Harvard School of Public Health, 401 Park Drive, 4th Floor West, Room 403-03, Boston, MA 02215, USA;
Contributors Study concept and design: BDC, LFB and MMG. Analysis and interpretation of data: BDC, JRM, LFB, MMG. Preparation of manuscript: BDC, JRM, LFB, MMG.
- Accepted 13 September 2011
- Published Online First 11 November 2011
Background Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.
Methods Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as ‘long-term caregiving’. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.
Results Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28).
Conclusions Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.
Funding The authors gratefully acknowledge financial support from the American Heart Association grants 09PRE2080078 (BDC) and 10SDG2640243 (MMG), the National Institute on Aging (AG034385-01) (MMG) and National Heart, Lung and Blood Institute (T32-HL098048-01) (JRM). The HRS (Health and Retirement Study) is sponsored by the National Institute on Ageing (grant number NIA U01AG009740) and is conducted by the University of Michigan. We presented parts of this work at the American Public Health Association Annual Meeting on 10 November 2010.
Competing interests None.
Ethics approval Ethics approval was provided by University of Michigan (original study) and Harvard School of Public Health (this analysis).
Provenance and peer review Not commissioned; externally peer reviewed.