O'Reilly Dermot, Rosato Michael, Maguire Aideen
Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland.
Int J Epidemiol. 2015 Dec;44(6):1959-69. doi: 10.1093/ije/dyv172.
Countries with advanced welfare systems are increasingly relying on the input of informal caregivers, and there are growing concerns for their mental and physical wellbeing. However, the evidence about the relationship between caregiving and mortality risk is less clear.
A census-based record linkage study with mortality follow-up of 33 months: participants totalled 1 122 779 individuals including 183 842 caregivers, of whom 28.2% (51 927) were providing 50 or more hours caregiving per week.
Over 33 months of follow-up a total of 29 335 deaths occurred, 2443 of these among caregivers. Mortality risk for caregivers was lower than for non-caregivers [hazard ratio (HR) = 0.72: 95% confidence interval (CI) = 0.69, 0.75 in the fully adjusted model], and the lower risk was evident even for those providing 50 or more h of caregiving per week (adjusted HR = 0.77: 95% CI = 0.71, 0.83 and 0.76: 95% CI = 0.69, 0.83 for men and women, respectively). There was no evidence that this relationship varied by either age or marital status. Even among people with chronic health problems such as poor mental health, caregivers had lower mortality risk than non-caregivers. Caregiving is associated with reduced mortality risk for most causes—for example, the risk of death from ischaemic heart disease for caregivers providing 50 or more h was 27% and 31% lower for men and for women, respectively, compared with non-caregivers (HR = 0.73: 95% CI = 0.60, 0.88 and HR = 0.69: 95% CI = 0.51, 0.92).
This large population-based study confirms that for the majority of caregivers the beneficial effects of caregiving in terms of short-term mortality risk appear to outweigh any negative effects, even among people with significant health problems. These results underscore the need for a reappraisal of how caregiving is perceived.
拥有先进福利制度的国家越来越依赖非正式照料者的投入,人们也越来越关注他们的身心健康。然而,关于照料与死亡风险之间关系的证据尚不明确。
一项基于人口普查的记录链接研究,对参与者进行了33个月的死亡率随访:参与者共计1122779人,其中包括183842名照料者,其中28.2%(51927人)每周提供50小时或以上的照料服务。
在33个月的随访中,共发生29335例死亡,其中2443例发生在照料者中。照料者的死亡风险低于非照料者[风险比(HR)=0.72:95%置信区间(CI)=0.69,0.75在完全调整模型中],即使对于那些每周提供50小时或以上照料服务的人来说,较低的风险也很明显(调整后的HR=0.77:95%CI=0.71,0.83,男性和女性分别为0.76:95%CI=0.69,0.83)。没有证据表明这种关系因年龄或婚姻状况而异。即使在患有慢性健康问题(如心理健康不佳)的人群中,照料者的死亡风险也低于非照料者。照料与大多数原因导致的死亡风险降低有关——例如,每周提供50小时或以上照料服务的照料者因缺血性心脏病死亡的风险,男性比非照料者低27%,女性低31%(HR=0.73:95%CI=0.60,0.88和HR=0.69:95%CI=0.51,0.92)。
这项基于大量人群的研究证实,对于大多数照料者来说,照料在短期死亡风险方面的有益影响似乎超过了任何负面影响,即使在有严重健康问题的人群中也是如此。这些结果强调了重新评估对照料的看法的必要性。