Informal caregiving and health status in the United States from the Behavioral Risk Factor Surveillance System: Effect modification by rurality

“Health care" is commonly thought to be exclusively provided by health professionals, such as physicians and nurses. Yet in the US there are 50 million caregivers who provide informal care to individuals living with disabilities and chronic illness, comprising a critical part of the healthcare delivery. The provision of informal care is essential both to the care recipients and to society because it reduces costs and strains on the healthcare system. Although there are positive health benefits of caregiving for the caregiver, the associations between caregiving and several negative health outcomes are well-documented. Few studies to date have examined how these associations differ by location and rurality, however. Therefore, the objective of this study was to assess how the association between caregiving and health status and specific health outcomes are modified by rurality. We used 2009 Behavioral Risk Factor Surveillance System (BRFSS) data to assess the potential for effect modification by rurality using stratification and adjusting for interaction terms. Our findings suggest that the negative associations between caregiving and several health outcomes, including self-reported health, exercise, and mental health status, are stronger for caregivers living in rural areas, compared to those in more urban areas. These findings suggest that caregivers in rural communities may be less likely to have the social support and infrastructure needed to. Additionally, these findings support the need to develop policies and programs designed to protect the health of rural informal caregivers, to maintain and strengthen this vital component of health care across the US.