The Impact of Rurality on the Associations between Informal Caregiving and Health in the United States: A County-Level Assessment

Steven A. Cohen, Virginia Commonwealth University
Monique J. Brown, Virginia Commonwealth University
Kenneth Chui, Tufts University

Over 50 million caregivers provide informal care to individuals living with disabilities and chronic illness, benefitting society by reducing costs and strains on the healthcare system. Associations between caregiving and negative health outcomes are well-documented. Few studies to date have examined if and how rurality alters these associations. The objective of this study was to assess how the associations between caregiving and health are modified by rurality. We used 2009 Behavioral Risk Factor Surveillance System (BRFSS) county-level data to assess potential effect modification by rurality using stratification and interaction terms. Our findings suggest that the negative associations between caregiving and three health outcomes, self-reported health, exercise, and mental health status, depend strongly upon county rurality, although the direction of the effect modification were inconsistent. Caregivers in rural communities experience more health-related consequences, possibly due to issues surrounding social support or infrastructure needed to mitigate these health effects of caregiving.