Department of Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.
Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan.
PLoS One. 2018 Mar 28;13(3):e0194919. doi: 10.1371/journal.pone.0194919. eCollection 2018.
Long-term care systems may alleviate caregiver burdens, particularly for those with fewer resources. However, it remains unclear whether socioeconomic disparity in caregiver burdens exists under a public, universal long-term care insurance (LTCI) system. This study examined income-based inequalities in caregiving time and depressive symptoms in Japanese older family caregivers. We further compared inequality in depressive symptoms with that of non-caregivers to evaluate whether family caregiving exacerbates this disparity.
Data were obtained from a cross-sectional, nationwide survey conducted by the Japan Gerontological Evaluation Study in 2013. Participants were functionally independent older adults aged ≥65 years (N = 21,584). Depressive symptoms were assessed using the Geriatrics Depression Scale (GDS); caregiving hours per week, household income, and other covariates were also assessed.
Family caregivers occupied 8.3% of the total. A Poisson regression model revealed that caregivers in lower income groups (compared to those in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to engage in ≥36 and ≥72 hours/week of caregiving, respectively. As for the GDS (≥5), an excess risk was found in the caregivers in lower (compared to higher) income groups (adjusted prevalence ratio: 1.57-3.10). However, an interaction effect of income by caregiving role indicated no significant difference in inequality between caregivers and non-caregivers (p = .603). The excess risk for GDS (≥5) in the caregivers compared to non-caregivers was observed across income groups.
Our findings revealed a possible disparity in family caregivers under the public LTCI system. Further studies should examine factors associated with longer caregiving hours in lower income households. Our findings also suggest the necessity for more efforts to alleviate depressive symptoms in family caregivers under the LTCI system regardless of income level, rather than exclusively supporting those with a low income.
长期护理系统可以减轻照顾者的负担，特别是对于那些资源较少的人。然而，在公共、普遍的长期护理保险（LTCI）制度下，照顾者负担是否存在社会经济差异仍不清楚。本研究考察了日本老年家庭照顾者基于收入的照顾时间和抑郁症状的不平等。我们进一步比较了抑郁症状的不平等与非照顾者的不平等，以评估家庭照顾是否加剧了这种差异。
数据来自于 2013 年日本老年评估研究进行的一项横断面、全国性调查。参与者为功能独立的 65 岁及以上老年人（N=21584）。使用老年抑郁量表（GDS）评估抑郁症状；每周照顾时间、家庭收入和其他协变量也进行了评估。
家庭照顾者占总数的 8.3%。泊松回归模型显示，收入较低组（与最高组相比）的照顾者每周从事≥36 和≥72 小时的照顾的可能性分别增加 1.32 至 1.95 倍和 1.63 至 2.68 倍。对于 GDS（≥5），收入较低组（与较高组相比）存在超额风险（调整后的患病率比：1.57-3.10）。然而，照顾角色的收入交互作用表明，照顾者和非照顾者之间的不平等没有显著差异（p=0.603）。与非照顾者相比，照顾者的 GDS（≥5）的超额风险在各个收入组中都存在。
我们的研究结果表明，在公共 LTCI 制度下，家庭照顾者可能存在差异。进一步的研究应检查低收入家庭中照顾时间较长的相关因素。我们的研究结果还表明，无论收入水平如何，LTCI 制度下都有必要努力减轻家庭照顾者的抑郁症状，而不仅仅是支持低收入者。
