The relationship of health activation with risk of future cardiovascular disease among rural family caregivers of patients with chronic illnesses

Abstract

Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association.

Objectives: Our aims were to determine (1) whether health activation independently predicts 10-year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10-year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses.

Methods: Health activation was measured using the Patient Activation Measure. The predicted 10-year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis.

Results: Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001).

Conclusions: We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex.

Keywords: 10‐year cardiovascular disease risk; Framingham Risk Score; patient activation; self‐management; sex differences.

Figure 1.

Distribution of Caregivers by Sex in each Health Activation Level. There were no significant differences in sex among the four levels of health activation (p = 0.891).

Figure 2.

Distribution of Caregivers by Sex in the Framingham Risk Score Groups. This reflects a significant association between sex and cardiovascular disease risk group (**p < 0.01)