Income-based inequalities in caregiving time and depressive symptoms among older family caregivers under the Japanese long-term care insurance system: A cross-sectional analysis.
Income-based inequalities in caregiving time and depressive symptoms among older family caregivers under the Japanese long-term care insurance system: A cross-sectional analysis.
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DOI：
10.1371/journal.pone.0194919
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Kondo K
中科院分区：
文献类型：
--
作者：
Saito T;Kondo N;Shiba K;Murata C;Kondo K
长期护理系统可以减轻照顾者的负担，特别是对那些资源较少的人。然而，目前尚不清楚的是，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。本研究调查了日本老年家庭照顾者在照顾时间和抑郁症状方面的收入不平等。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2013年日本老年学评估研究进行的一项横断面全国调查。参与者为≥65岁功能独立的老年人（N = 21,584）。采用老年抑郁量表（GDS）评估抑郁症状；每周照顾时间、家庭收入和其他协变量也被评估。家庭照顾者占8.3%。泊松回归模型显示，低收入群体照料者每周照料时间≥36小时和≥72小时的可能性分别是高收入群体的1.32 ~ 1.95倍和1.63 ~ 2.68倍。对于GDS(≥5)，低收入组（与高收入组相比）护理人员存在额外风险（调整患病率：1.57-3.10）。然而，收入与照顾角色的交互作用表明照顾者与非照顾者之间的不平等没有显著差异（p = .603）。与非照顾者相比，照顾者的GDS风险（≥5）高于不同收入群体。我们的研究结果揭示了公共LTCI系统下家庭照顾者可能存在的差异。进一步的研究应该检查低收入家庭中照料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，都需要更多的努力来减轻LTCI系统下家庭照顾者的抑郁症状，而不是只支持低收入者。
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.
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影响因子：
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