title: Spousal caregiving and incident hypertension.
abstract: BACKGROUND
  Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults.
  
  
  METHODS
  Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs.
  
  
  RESULTS
  After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings.
  
  
  CONCLUSIONS
  Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA. bcapistr@hsph.harvard.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Capistrant
authors.forename: J Robin
authors.initials: JR
authors.lastname: Moon
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D017028:Caregivers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D008297:Male; D008569:Memory Disorders / Q000628:therapy; D008875:Middle Aged; D016017:Odds Ratio; D018454:Spouses; D013315:Stress, Psychological / Q000150:complications