Lambrias Ameer, Taouk Yamna, Ervin Jennifer, King Tania
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
PLoS One. 2025 Jun 9;20(6):e0323245. doi: 10.1371/journal.pone.0323245. eCollection 2025.
Engaging in chronically stressful behaviours has been hypothesised to increase the risk of experiencing cardiovascular disease (CVD). Providing unpaid care is known to be a stressful activity, but it is not clear whether this caregiving is associated with CVD. This study filled a gap in the existing literature by examining the association between providing unpaid care and incident cardiovascular disease among a nationally representative sample of Australian adults.
11,123 adult participants aged over 18 years from the Household Income and Labour Dynamics in Australia (HILDA) survey were followed for up to 14 years from baseline (2003) until 2017. Gender-stratified survival analysis models used self-reported caregiving and heart disease statuses as well as time-varying covariates, to assess the association between providing high-intensity or low-intensity unpaid care (to an elderly or disabled relative) and incident CVD in comparison with a non-caregiving control.
Among females, there was weak evidence that CVD was associated with high-intensity unpaid care (HR = 1.27, 95% CI = [0.83, 1.95]) and no evidence for low-intensity unpaid care (HR = 0.79, 95% CI = [0.50, 1.26]) in comparison with non-carers after adjusting for confounders. There was no association between caregiving and incident CVD for high-intensity (HR = 0.82, 95% CI = [0.47, 1.42]) or low-intensity (HR = 0.84, 95% CI = [0.55, 1.28]) caregiving males in the adjusted models.
These findings do not provide strong evidence to reject the null hypothesis that providing unpaid care does not increase risk of developing CVD in the Australian population. Given that these findings are somewhat inconsistent with the extant literature from other populations, further research is necessary, both in Australia and internationally, to build on the findings of this study and improve understanding of the nature of the association between caregiving and incident CVD.
长期从事压力大的行为被认为会增加患心血管疾病（CVD）的风险。众所周知，提供无偿护理是一项压力大的活动，但尚不清楚这种护理是否与心血管疾病有关。本研究通过在具有全国代表性的澳大利亚成年人样本中，检验提供无偿护理与心血管疾病发病之间的关联，填补了现有文献的空白。
对澳大利亚家庭收入与劳动力动态调查（HILDA）中11123名年龄在18岁以上的成年参与者，从基线（2003年）开始随访长达14年，直至2017年。性别分层生存分析模型使用自我报告的护理情况和心脏病状况以及随时间变化的协变量，以评估与非护理对照组相比，提供高强度或低强度无偿护理（照顾老年或残疾亲属）与心血管疾病发病之间的关联。
在女性中，调整混杂因素后，与非护理者相比，有微弱证据表明心血管疾病与高强度无偿护理有关（风险比[HR]=1.27，95%置信区间[CI]=[0.83，1.95]），而没有证据表明与低强度无偿护理有关（HR=0.79，95%CI=[0.50，1.26]）。在调整后的模型中，高强度（HR=0.82，95%CI=[0.47，1.42]）或低强度（HR=0.84，95%CI=[0.55，1.28]）护理的男性，护理与心血管疾病发病之间没有关联。
这些发现没有提供有力证据来拒绝原假设，即提供无偿护理不会增加澳大利亚人群患心血管疾病的风险。鉴于这些发现与其他人群的现有文献有些不一致，在澳大利亚和国际上都有必要进行进一步研究，以基于本研究的结果，增进对护理与心血管疾病发病之间关联性质的理解。
