Department of Health and Exercise Science, Appalachian State University, Boone, North Carolina.
Association of State and Territorial Health Officials, Washington, DC.
J Rural Health. 2018 Jun;34(3):263-274. doi: 10.1111/jrh.12273. Epub 2017 Sep 23.
To assess whether financial or health-related barriers were more common among rural caregivers and whether rural caregivers experienced more caregiving-related difficulties than their urban peers.
We used data from 7,436 respondents to the Caregiver Module in 10 states from the 2011-2013 Behavioral Risk Factor Surveillance System. Respondents were classified as caregivers if they reported providing care to a family member or friend because of a long-term illness or disability. We classified respondents as living in a rural area if they lived outside of a Metropolitan Statistical Area (MSA). We defined a financial barrier as having an annual household income <$25,000 or not being able see a doctor when needed in the past year because of cost. We defined a health barrier as having multiple chronic health conditions, a disability, or fair or poor self-rated health.
Rural caregivers more frequently had financial barriers than urban caregivers (38.1% vs 31.0%, P = .0001), but the prevalence of health barriers was similar (43.3% vs 40.6%, P = .18). After adjusting for demographic differences, financial barriers remained more common among rural caregivers. Rural caregivers were less likely than their urban peers to report that caregiving created any difficulty in both unadjusted and adjusted models (adjusted prevalence ratio = 0.90; P < .001).
Informal caregivers, particularly in rural areas, face financial barriers. Rural caregivers were less likely than urban caregivers to report caregiving-related difficulties. Rural caregivers' coping strategies or skills in identifying informal supports may explain this difference, but additional research is needed to explore this hypothesis.
评估经济或健康相关障碍在农村照顾者中更为常见，以及农村照顾者是否比城市同行面临更多的照顾相关困难。
我们使用了来自 2011-2013 年行为风险因素监测系统 10 个州的照顾者模块的 7436 名受访者的数据。如果受访者报告因为长期疾病或残疾而照顾家庭成员或朋友，则将其归类为照顾者。如果他们居住在大都市区（MSA）之外，则将其归类为居住在农村地区。我们将经济障碍定义为年收入<$25,000，或过去一年因费用而无法按需就医。我们将健康障碍定义为患有多种慢性健康状况、残疾或自我评定健康状况一般或较差。
农村照顾者比城市照顾者更频繁地面临经济障碍（38.1%比 31.0%，P=.0001），但健康障碍的患病率相似（43.3%比 40.6%，P=.18）。在调整了人口统计学差异后，农村照顾者仍然更有可能面临经济障碍。在未经调整和调整后的模型中，农村照顾者比城市同行更不可能报告照顾带来任何困难（调整后的患病率比=0.90；P<.001）。
非正式照顾者，特别是在农村地区，面临经济障碍。农村照顾者比城市照顾者更不可能报告与照顾相关的困难。农村照顾者的应对策略或识别非正式支持的技能可能解释了这种差异，但需要进一步研究来探讨这一假设。
