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Research ArticleOriginal Research

Caregiving in a Pandemic: Health-Related Socioeconomic Vulnerabilities Among Women Caregivers Early in the COVID-19 Pandemic

Kelly Boyd, Victoria Winslow, Soo Borson, Stacy Tessler Lindau and Jennifer A. Makelarski
The Annals of Family Medicine September 2022, 20 (5) 406-413; DOI: https://doi.org/10.1370/afm.2845
Kelly Boyd
1The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois
MA
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Victoria Winslow
1The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois
MPH
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Soo Borson
2University of Southern California Keck School of Medicine, Department of Family Medicine, Los Angeles, California
MD
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Stacy Tessler Lindau
1The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois
3The University of Chicago, Department of Medicine-Geriatrics, Chicago, Illinois
MD, MAPP
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Jennifer A. Makelarski
1The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois
4Benedictine University, College of Science and Health, Lisle, Illinois
PhD, MPH
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  • For correspondence: jmakelarski@bsd.uchicago.edu
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    Figure 1.
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    Figure 1.

    Weighted prevalence of pre-pandemic socioeconomic vulnerabilities (A) and early pandemic changes in socioeconomic vulnerabilities (B) by caregiving status.

    AHC = accountable health communities; HRSV = health-related socioeconomic vulnerabilities; IPV = interpersonal violence.

    Note: Calibration weights were utilized and were generated based on the following variables: age group, race, education, income, and region. Change in each HRSV was categorized as: secure (absent pre-pandemic and early pandemic), incident (absent pre-pandemic and present early pandemic), persistent or improved (present pre-pandemic and unchanged or improved early pandemic), and worsening (present pre-pandemic and worse early pandemic).

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    Figure 2.

    Adjusted odds of socioeconomic vulnerabilities: pre-pandemic (A), incident (B), and worsening (C) for caregivers compared with non-caregivers (referent group).

    HRSV = health-related socioeconomic vulnerabilities.

    Notes: Calibration weights were utilized and were generated based on the following variables: age group, race, education, income, and region. Sample sizes for participants with incident utilities (B) and participants with worsening housing (C) were too small to include in the models. Models adjusted for age, race/ethnicity, marital status, education, income, number of people in household, number of children in household, self-reported physical health and mental health, and number of comorbidities. Change in each HRSV was categorized as: secure (absent pre-pandemic and early pandemic), incident (absent pre-pandemic and present early pandemic), persistent or improved (present pre-pandemic and unchanged or improved early pandemic), and worsening (present pre-pandemic and worse early pandemic).

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    Table 1.

    Weighted Baseline Characteristics by Caregiving Status (N = 3,167)

    CharacteristicNon-Caregiver
    (n = 2,217), %
    Caregiver
    (n = 950), %
    P Value
    Age, y
        18-4442.948.5<.01
        45-6432.833.4
        ≥6524.218.1
    Race/Ethnicity
        White67.260.8<.01
        Hispanic12.417.0
        Black10.012.0
        Asian  5.9  3.7
        Other  4.4  6.5
    Education
        >High school diploma63.361.7.48
        ≤High school diploma36.738.3
    Partnership status
        Married61.163.9.18
        Unmarried/Single38.936.1
    Income, $ per year
        <25,00019.320.3.03
        25,000-49,99920.523.2
        50,000-99,99929.331.8
        ≥100,00030.924.7
    Employment
        Employed43.455.8<.01
        Unemployed  7.5  5.7
        Unemployed by choice or unable to work49.138.5
    Household composition
        117.311.4<0.01
        236.329.8
        ≥346.458.8
    Number of children living at home
        064.353.5<.01
        116.220.4
        ≥219.526.1
    Self-rated mental health
        Excellent or very good52.247.4<.05
        Good29.831.1
        Fair or poor18.021.6
    Self-rated overall health
        Excellent or very good44.939.3.04
        Good36.739.4
        Fair or poor18.521.3
    Number of comorbidities
        057.943.5<.01
        126.636.1
        2  9.712.0
        ≥3  5.9  8.3
    • Notes: Calibration weights were utilized and were generated based on the following variables: age group, race, education, income, and region. Participants were given a list of 13 common comorbidities and asked to identify which conditions a doctor or health care clinician had told them they had.

    • View popup
    Table 2.

    Weighted Pre-Pandemic Prevalence of Caregiver Socioeconomic Vulnerabilities by Condition of Care Recipient

    Caregiver
    Vulnerabilities
    Care Recipient Conditions
    Arthritis/Rheumatism
    (n = 47), %
    Asthma
    (n = 73), %
    Cancer
    (n = 69), %
    Chronic Respiratory Condition
    (n = 59), %
    ADRD
    (n = 67), %
    Diabetes
    (n = 94), %
    Heart Disease/Hypertension/Stroke
    (n = 88), %
    Mental Illness
    (n = 106), %
    Old Age/Infirmity/Frailty
    (n = 119), %
    ≥1 Socioeconomic vulnerability87.478.056.056.846.976.259.365.345.2
    Financial strain62.658.830.044.023.153.244.742.626.4
    Food insecurity65.963.743.237.433.458.742.851.832.0
    Housing11.222.714.8  6.616.516.213.610.3  5.9
    Interpersonal violence21.821.1  7.9  6.5  9.017.8  8.113.9  7.0
    Transportation48.229.328.517.6  9.139.416.131.1  9.8
    Utilities19.017.610.318.0  5.518.8  9.615.7  5.8
    • ADRD = Alzheimer’s disease and related dementias.

    • Note: Calibration weights were utilized and were generated based on the following variables: age group, race, education, income, and region.

Additional Files

  • Figures
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  • VISUAL ABSTRACT BELOW IN PNG FORMAT

    • Makelarski_visualabsrtact_20.6_v003.png
  • SUPPLEMENTAL TABLES BELOW IN PDF FILE

    Supplemental Table 1. Survey Items Used to Assess Change in Socioeconomic Vulnerabilities
    Supplemental Table 2. Unadjusted and Adjusted Odds of Experiencing Pre-pandemic Health-Related Socioeconomic Vulnerabilities, Comparing Caregivers to Non- Caregivers (Reference Group)
    Supplemental Table 3. Unadjusted and Adjusted Odds of Experiencing or Worsening Health-Relate Socioeconomic Vulnerabilities in the Early Pandemic, Comparing Caregivers to Non-caregivers (reference Group)
    Supplemental Table 4. Pre-pandemic, Early Pandemic, and Change in Prevalence of Experiencing Health-Related Socioeconomic Vulnerabilities, Stratified by Caregiving Status
    Supplemental Appendix. Stata/SE v.17.0 Output for Tables 1 and 2 and Figures 1 and 2

    • MakelarskiSupp.pdf
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The Annals of Family Medicine: 20 (5)
The Annals of Family Medicine: 20 (5)
Vol. 20, Issue 5
September/October 2022
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Caregiving in a Pandemic: Health-Related Socioeconomic Vulnerabilities Among Women Caregivers Early in the COVID-19 Pandemic
Kelly Boyd, Victoria Winslow, Soo Borson, Stacy Tessler Lindau, Jennifer A. Makelarski
The Annals of Family Medicine Sep 2022, 20 (5) 406-413; DOI: 10.1370/afm.2845

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Caregiving in a Pandemic: Health-Related Socioeconomic Vulnerabilities Among Women Caregivers Early in the COVID-19 Pandemic
Kelly Boyd, Victoria Winslow, Soo Borson, Stacy Tessler Lindau, Jennifer A. Makelarski
The Annals of Family Medicine Sep 2022, 20 (5) 406-413; DOI: 10.1370/afm.2845
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