Current and long-term spousal caregiving and onset of cardiovascular disease.

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans. METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD. RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28). CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

Self-reported and measured hypertension among older US- and foreign-born adults.

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.