abstract: 'Aim

  Long-term care systems may alleviate caregiver burdens, particularly for

  those with fewer resources. However, it remains unclear whether

  socioeconomic disparity in caregiver burdens exists under a public,

  universal long-term care insurance (LTCI) system. This study examined

  income-based inequalities in caregiving time and depressive symptoms in

  Japanese older family caregivers. We further compared inequality in

  depressive symptoms with that of non-caregivers to evaluate whether

  family caregiving exacerbates this disparity.

  Methods

  Data were obtained from a cross-sectional, nationwide survey conducted

  by the Japan Gerontological Evaluation Study in 2013. Participants were

  functionally independent older adults aged >= 65 years (N=21,584).

  Depressive symptoms were assessed using the Geriatrics Depression Scale

  (GDS); caregiving hours per week, household income, and other covariates

  were also assessed.

  Results

  Family caregivers occupied 8.3\% of the total. A Poisson regression

  model revealed that caregivers in lower income groups (compared to those

  in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to

  engage in >= 36 and >= 72 hours/week of caregiving, respectively. As for

  the GDS (>= 5), an excess risk was found in the caregivers in lower

  (compared to higher) income groups (adjusted prevalence ratio:

  1.57-3.10). However, an interaction effect of income by caregiving role

  indicated no significant difference in inequality between caregivers and

  non-caregivers (p = .603). The excess risk for GDS (>= 5) in the

  caregivers compared to non-caregivers was observed across income groups.

  Conclusions

  Our findings revealed a possible disparity in family caregivers under

  the public LTCI system. Further studies should examine factors

  associated with longer caregiving hours in lower income households. Our

  findings also suggest the necessity for more efforts to alleviate

  depressive symptoms in family caregivers under the LTCI system

  regardless of income level, rather than exclusively supporting those

  with a low income.'
affiliation: 'Saito, T (Corresponding Author), Natl Ctr Geriatr \& Gerontol, Dept
  Social Sci, Obu, Japan.

  Saito, Tami; Murata, Chiyoe, Natl Ctr Geriatr \& Gerontol, Dept Social Sci, Obu,
  Japan.

  Kondo, Naoki; Shiba, Koichiro, Univ Tokyo, Dept Hlth \& Social Behav, Sch Publ Hlth,
  Tokyo, Japan.

  Shiba, Koichiro, Harvard TH Chan Sch Publ Hlth, Dept Social \& Behav Sci, Boston,
  MA USA.

  Kondo, Katsunori, Chiba Univ, Ctr Prevent Med Sci, Chiba, Japan.

  Kondo, Katsunori, Natl Ctr Geriatr \& Gerontol, Dept Gerontol Evaluat, Obu, Japan.'
article-number: e0194919
author: Saito, Tami and Kondo, Naoki and Shiba, Koichiro and Murata, Chiyoe and Kondo,
  Katsunori
author-email: t-saito@ncgg.go.jp
author_list:
- family: Saito
  given: Tami
- family: Kondo
  given: Naoki
- family: Shiba
  given: Koichiro
- family: Murata
  given: Chiyoe
- family: Kondo
  given: Katsunori
da: '2023-09-28'
doi: 10.1371/journal.pone.0194919
files: []
issn: 1932-6203
journal: PLOS ONE
keywords-plus: 'INFORMAL CARE; BURDEN; HEALTH; DEMENTIA; SCALE; INTERVENTIONS;

  PREDICTORS; DISABILITY; PEOPLE; WORK'
language: English
month: MAR 28
number: '3'
number-of-cited-references: '45'
orcid-numbers: 'Kondo, Naoki/0000-0002-6425-6844

  Kondo, Naoki/0000-0002-6425-6844

  Shiba, Koichiro/0000-0001-7956-6485'
papis_id: 631f4a98828aee4e9fa30cb35e67c35d
ref: Saito2018incomebasedinequalit
researcherid-numbers: 'Kondo, Naoki/ABC-5865-2020

  Kondo, Naoki/K-3898-2012

  Kondo, Katsunori/AAI-6373-2020

  '
times-cited: '22'
title: 'Income-based inequalities in caregiving time and depressive symptoms among
  older family caregivers under the Japanese long-term care insurance system: A cross-sectional
  analysis'
type: Article
unique-id: WOS:000428603100089
usage-count-last-180-days: '1'
usage-count-since-2013: '14'
volume: '13'
web-of-science-categories: Multidisciplinary Sciences
year: '2018'