Title: Informal Caregiver Assistance among Adults with Cardiovascular Disease in Ohio
1Informal Caregiver Assistanceamong Adults with
CardiovascularDisease in Ohio
- Deborah A. Levine, MD, MPH
- Assistant Professor of Medicine
- Division of General Internal Medicine
- Division of Health Services Management Policy
- The Ohio State University
2Co-Investigators
- Sudeep Karve, PhD
- Eric Seiber, PhD
- Al Dembe, ScD
- Andrew Slivka, MD
- Bo Lu, PhD
3Cardiovascular Disease (CVD) in Ohio
- Leading cause of death in the US and Ohio
accounting for 35-40 of deaths - Prevalence is increasing in US and Ohio
- Self-reported prevalence of CVD in Ohio adults
(OFHS 2008) - Heart attack (5.4)
- Coronary heart disease (6.3)
- Stroke (3.5)
- Congestive heart failure (3.0)
- Effect of CVD prevalence on use and costs of
health care and non-health care services are
unknown
4CVD and Caregiver Assistance
- CVD associated with increased disability, need
for home and community-based services and
caregiver assistance, even long-term - Caregiver assistance may have adverse effects on
caregiver, health care system, and employers - Caregiver assistance important for adult Medicaid
recipients with CVD - Amount and cost of caregiver assistance for
adults with CVD in Ohio are unknown
5Study Aims
- To assess current prevalence of informal
caregiver assistance for adults reporting a
history of CVD for the state of Ohio. - To determine whether caregiver assistance for
adults with CVD is higher among the four priority
CVD populations for the state of Ohio men,
African-Americans, Appalachians, and those living
in poverty. - To estimate the cost of caregiver assistance for
adults with CVD in Ohio using 2007 US Bureau of
Labor Statistics wage rates. - To estimate the amount and cost of caregiver
assistance for adults with CVD in Ohio who are
Medicaid recipients.
6Methods Patient Population
- Ohio Family Health Survey 2008
- 7,040 adults aged 18 years with history of CVD
(heart attack, coronary heart disease, stroke or
congestive heart failure (CHF)) - 42,681 adults aged 18 years without CVD
- Compared amount of self-reported informal
caregiver assistance, measured in mean hours per
person per month, by CVD status
7Methods Outcome Definition
- Caregiver assistance currently need any of the
following types of assistance because of health
problems - Assistance with personal care (hygiene, feeding)
- Domestic assistance (housekeeping,
transportation) - Help with household maintenance (painting, yard
work) - Social or emotional support (companionship,
recreation) - Coordinating health care (making medical
appointments) - Assistance managing financial affairs
- Other kinds of assistance
- How many hours of assistance do you currently
require on average for the types of assistance
that were just mentioned?
8Methods Analysis
- Two-part regression model
- First part logistic regression models estimated
the probability of reporting informal caregiver
assistance for respondents with and without CVD,
before and after adjusting for covariates - Second part ordinary least squares regression
examined the association of CVD category with
natural logarithm of informal caregiver
assistance hours per month for respondents who
reported any informal caregiver assistance - Combined results of two models to obtain an
estimate of the average effect of CVD on monthly
hours of informal caregiver assistance required
per person (unconditional effect of CVD) - Regression model results were retransformed to
hours - Statistical analysis STATA
- Complex sampling design
- Weighted results
9Methods Regression Model
Co-morbidity included hypertension, diabetes,
cigarette smoking
10Methods Cost Analysis
- Used market price of equivalent service/worker to
estimate opportunity cost for the time of an
informal caregiver - Estimated the annual cost of informal caregiver
assistance attributable to CVD - Multiplied the adjusted monthly hours of informal
caregiver assistance per person attributable to
CVD by the 2007 US Bureau of Labor Statistics
median wages for a home health aide (9.15/hour) - Multiplied by 12 (months per year)
- Multiplied by the population estimate of the
number of adults Ohioans with CVD in 2008 - Repeated analysis for recipients of any Medicaid
and recipients of Medicaid and Medicare
11CVD Prevalence in Ohio, Overall and by Age Group,
2008
12Characteristics of Adults with CVD in Ohio, 2008
13Characteristics of Adults with CVD in Ohio, 2008
14Characteristics of Adults with CVD in Ohio, 2008
15Percentage of Adults with Cardiovascular Disease
(CVD) Reporting Informal Caregiver Assistance in
Ohio, Overall and by Age, 2008
16Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio
by Type of Cardiovascular Disease, 2008
17Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Gender and Age, 2008
18Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Race/Ethnicity, 2008
19Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Region, 2008
20Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Poverty Level, 2008
21Cost of Informal Caregiver Assistance
Attributable to Cardiovascular Disease (CVD)
among Adults in Ohio, 2008
Adjusted for age, gender, race/ethnicity,
region, poverty level, education, marital status,
number of adults in household, health insurance,
co-morbidity, health status, and number of
hospitalizations in last year.
22Cost of Informal Caregiver Assistance
Attributable to Cardiovascular Disease (CVD)
among Adults in Ohio, 2008
23Adult Medicaid Recipients with CVD
- Approximately 120,000 adults with CVD are
recipients of Medicaid of whom 65 report
informal caregiver assistance. - The average yearly cost of informal caregiver
assistance attributable to CVD was 694 per
person. - Approximately 71,000 adults with CVD are
recipients of Medicaid and Medicare of whom 65
report informal caregiver assistance. - The average yearly cost of informal caregiver
assistance attributable to CVD was 1471 per
person.
24Type of Informal Caregiver Assistance among
Adults Reporting Help with Only One Activity
25Limitations
- Self-report of informal caregiver assistance may
underestimate infrequent assistance - Self-report of CVD
- Severity of CVD, onset of CVD, quality of CVD
care, dementia, rehabilitation cannot be assessed - Limited to community-dwelling adults
- No direct measure of caregiver assistance by
type, provider, or disease (due to CVD or other
condition) - Cost estimates used median hourly wage for a home
health aide but some informal care may or may not
be performed by a home health aide (e.g.,
social/emotional support)
26Conclusions
- Informal caregiver assistance for adults with CVD
in Ohio is substantial and costly. - Approximately 50 of community-dwelling adult
Ohioans with CVD report informal caregiver
assistance. - Priority CVD populations reported more informal
care - Non-Hispanic blacks
- Hispanics
- Appalachians
- Adults living in poverty
- Stroke and CHF had highest rates of informal
care. - Estimated 2008 annual cost of informal caregiver
assistance attributable to CVD was 563 million
for Ohio.
27Policy Implications
- Expand or more efficiently allocate resources to
provide home and community-based care. - Assess availability and quality of current
resources and programs to provide home and
community-based care, particularly for the
elderly. - Develop and implement programs to identify care
needs. - Focus on vulnerable populations (non-Hispanic
blacks, Hispanics, those living in Appalachia,
those living in poverty, the elderly, women) who
may require ancillary health care and social
services. - Coordinate home-based and community resources
across agencies. - Streamline the applications for services by
patients and their caregivers.
28Policy Implications
- To address caregiver burden
- Ensure adequate availability and duration of
family medical leave for employed caregivers. - Increase the availability and health insurance
coverage of respite care. - Ensure the availability and health insurance
coverage of counseling and support services.
29Acknowledgements
- Melissa Senter, MA, MPH
- Rosemary Duffy, DDS, MPH
- Barry Jamieson, MA
- Find full report at http//grc.osu.edu/ofhs
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