title: Current and long-term spousal caregiving and onset of cardiovascular disease.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02215, USA. bcapistr@hsph.harvard.edu
authors.forename: Beatrix Davoli
authors.initials: BD
authors.lastname: Capistrant
authors.forename: J Robin
authors.initials: JR
authors.lastname: Moon
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D057566:Self Report; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications; D014481:United States / Q000453:epidemiology
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