Spousal caregiving and incident hypertension.
Spousal caregiving and incident hypertension.
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DOI：
10.1038/ajh.2011.232
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发表时间：
2012-04
影响因子：
3.2
通讯作者：
Glymour, M. Maria
中科院分区：
文献类型：
--
作者：
Capistrant, Benjamin D.;Moon, J. Robin;Glymour, M. Maria
照顾配偶与健康状况不佳有关，包括心血管疾病发病和死亡的风险。然而，很少有研究评估与配偶离婚相关的高血压事件的风险。本文调查了这种关联在一个大的，全国代表性的美国老年人样本。2000年，已婚、无高血压、健康与退休研究（HRS）50岁以上的受访者（n= 5，708）接受了长达8年的随访（1，708例新的自我报告的高血压诊断）。目前的护理暴露定义为协助配偶进行工具性或基本日常生活活动（I/ADL）14小时/周以上;我们将连续两次两年期调查中提供≥14小时/周护理定义为“长期护理”。我们使用了逆概率加权离散时间风险模型，其中包含了时间更新的暴露和协变量，以估计当前和长期暴露对高血压事件的影响。我们测试了种族、性别和接受者记忆疾病的影响。敏感性分析仅限于配偶有护理需求的受访者。在调整了人口统计学、社会经济学和健康因素（包括危险行为、共病状况和自评健康状况）后，当前年龄显著预测高血压发病率（RR=1.36，95%CI：1.01，1.83）。对于长期照顾者，有显著证据表明，高血压发作的风险与生育相关（RR=2.29，95%CI：1.17，4.49）。与当前和长期随访相关的高血压发病风险不因种族、性别或接受者记忆疾病诊断而变化。敏感性分析支持主要结果。在一项具有全国代表性的美国成年人样本中，为配偶提供I/ADL护理可显著预测高血压发作。
Caring for one’s spouse has been associated with poor health, including risk of cardiovascular disease onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults. Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n=5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (I/ADLs) 14+ hours/week; we define providing ≥14 hours/week of care at two consecutive biennial surveys as “long-term caregiving.” We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs. After adjusting for demographic, socioeconomic and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (RR=1.36, 95% CI: 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR=2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings. Providing I/ADL care to a spouse significantly predicted hypertension onset in a nationally-representative sample of US adults.
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