Informal Caregiving, Chronic Physical Conditions, and Physical Multimorbidity in 48 Low- and Middle-Income Countries

Louis Jacob, Hans Oh, Jae Il Shin, Josep Maria Haro, Davy Vancampfort, Brendon Stubbs, Sarah E Jackson, Lee Smith, Ai Koyanagi, Louis Jacob, Hans Oh, Jae Il Shin, Josep Maria Haro, Davy Vancampfort, Brendon Stubbs, Sarah E Jackson, Lee Smith, Ai Koyanagi

Abstract

Background: The health of the caregivers is crucial to sustain informal care provision, while multimorbidity is an important health risk concept. However, studies on the association between informal caregiving and physical multimorbidity are currently lacking. Therefore, we investigated this association in adults from 48 low- and middle-income countries (LMICs).

Method: Cross-sectional data from 242,952 adults (mean age 38.4 years) participating in the World Health Survey 2002-2004 were analyzed. Informal caregivers were considered those who provided help in the past year to a relative or friend (adult or child) who has a long-term physical or mental illness or disability, or is getting old and weak. Nine physical conditions were assessed. Multivariable logistic regression analyses were conducted to assess associations between informal caregiving and physical multimorbidity, while the between-country heterogeneity in this relationship was studied with country-wise analyses.

Results: The overall prevalence of informal caregiving and physical multimorbidity (ie, two or more physical conditions) was 19.2% and 13.2%, respectively. Overall, caregivers had 1.40 (95% confidence interval = 1.29-1.52) times higher odds for physical multimorbidity. This association was particularly pronounced in younger caregivers (eg, 18-44 years: odds ratio = 1.54; 95% confidence interval = 1.37-1.72), whereas this association was not statistically significant among those aged ≥65 and older (odds ratio = 1.19; 95% confidence interval = 0.98-1.44). Country-wise analyses corroborated these findings, and there was a negligible level of between-country heterogeneity (I2 = 24.0%).

Conclusions: In LMICs, informal caregivers (especially young caregivers) were more likely to have physical multimorbidity. This should be taken into account in policies that address the health and well-being of informal caregivers.

Keywords: Chronic physical conditions; Cross-sectional multicountry study; Informal caregiving; Low- and middle-income countries; Physical multimorbidity.

© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.

Figures

Figure 1.
Figure 1.
Prevalence of caregiving by number of chronic physical conditions.
Figure 2.
Figure 2.
Prevalence of chronic physical conditions and multimorbidity among noncaregivers and caregivers. Bars denote 95% confidence intervals. Multimorbidity was defined as two or more chronic conditions.
Figure 3.
Figure 3.
Association between caregiving (exposure) and multimorbidity (outcome) estimated by multivariable logistic regression. Models are adjusted for age, sex, education, wealth, employment, and country with the exception of samples consisting only of males or females, which were not adjusted for sex. Multimorbidity was defined as two or more chronic conditions. OR = odds ratio; CI = confidence interval.
Figure 4.
Figure 4.
Country-wise association between caregiving (exposure) and multimorbidity (outcome) estimated by multivariable logistic regression. Models are adjusted for age, sex, education, wealth, and employment. Overall estimate was obtained by meta-analysis with fixed effects. Multimorbidity was defined as two or more chronic conditions. OR = odds ratio; CI = confidence interval.

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