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

Abstract

Purpose: Family and friends who provide regular care for a sick or dependent individual ("caregivers") are at increased risk of health-related socioeconomic vulnerabilities (HRSVs). This study examined pre-pandemic prevalence of and early pandemic changes in HRSVs among women caregivers compared with non-caregivers.

Methods: A cross-sectional survey was conducted in April 2020 (early pandemic) with 3,200 English-speaking US women aged 18 years or older, 30% of whom identified as caregivers. We modeled adjusted odds of self-reported HRSVs (financial strain, food/housing insecurity, interpersonal violence, transportation/utilities difficulties) before and changes during the early pandemic by caregiving status. Models were adjusted for age, race/ethnicity, marital status, education, income, number of people in household, number of children in household, physical and mental health, and number of comorbidities.

Results: Pre-pandemic, 63% of caregivers and 47% of non-caregivers reported 1 or more vulnerability (P <.01); food insecurity was most prevalent (48% of caregivers vs 33% of non-caregivers, P <.01). In the early pandemic, caregivers had higher odds than non-caregivers of financial strain, both incident (adjusted odds ratio [AOR] = 2.1; 95% CI, 1.6-2.7) and worsening (AOR = 2.0; 95% CI, 1.4-2.8); incident interpersonal violence (AOR = 2.0; 95% CI, 1.5-2.7); incident food insecurity (AOR = 1.6; 95% CI, 1.2-2.1); incident transportation difficulties (AOR = 1.9; 95% CI, 1.3-2.6); and incident housing insecurity (AOR = 1.6; 95% CI, 1.1-2.3).

Conclusion: The coronavirus disease 2019 (COVID-19) pandemic increased risk of incident and worsening HRSVs for caregivers more than for non-caregivers. COVID-19 response and recovery efforts should target caregivers to reduce modifiable HRSVs and promote the health of caregivers and those who depend on them.Annals Online First article.

Keywords: COVID-19 pandemic; caregivers; food insecurity; social care; social determinants of health.

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).

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).

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).