title: Socioeconomic and demographic factors modify the association between informal caregiving and health in the Sandwich Generation.
abstract: BACKGROUND
  Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the "sandwich generation", providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors.
  
  
  METHODS
  We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity.
  
  
  RESULTS
  The association between informal caregiving and health varied by membership in the "sandwich generation," income, and race/ethnicity. This association was significant among subjects with one (OR=1.13, 95% CI [1.04, 1.24]) and two or more children (OR=1.17, 95% CI=1.09, 1.26]), but not in those without children (OR=1.01, 95% CI [0.97, 1.05]). Associations were strongest in those earning $50,000-$75,000 annually, but these income-dependent associations varied by race/ethnicity. In Whites with two or more children, the strongest associations between caregiving and health occurred in lower income individuals. These trends were not observed for Whites without children.
  
  
  CONCLUSIONS
  Our findings suggest that the added burden of caregiving for both children and elderly relatives may be impacted by income and race/ethnicity. These differences should be considered when developing culturally appropriate interventions to improve caregiver health and maintain this vital component of the US health care system.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Do
authors.affiliation: Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, 830 East Main Street- 8th Floor, Richmond, Virginia 23298, USA. scohen@vcu.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D002648:Child; D005006:Ethnicity; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D011159:Population Surveillance; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
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