Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7–45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ahn, S., Hochhalter, A. K., Moudouni, D. K. M., Smith, M. L., & Ory, M. G. (2012). Self-reported physical and mental health of older adults: The roles of caregiving and resources. Maturitas, 71(1), 62–69.
Alexander, T., & Wilz, G. (2010). Family caregivers: Gender differences in adjustment to stroke survivors' mental changes. Rehabilitation Psychology, 55(2), 159–169.
Allison, P. D. (2000). Multiple imputation for missing data: A cautionary tale. Sociological Methods & Research, 28(3), 301–309.
American Association for Retired Persons and National Alliance for Caregiving (2015). Caregiving in the U.S. http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf. Accessed June 13, 2017.
Anderson, L. A., Edwards, V. J., Pearson, W. S., Talley, R. C., McGuire, L. C., & Andresen, E. M. (2013). Adult caregivers in the United States: Characteristics and differences in well-being, by caregiver age and caregiving status. Preventing Chronic Disease, 10, E135.
Bauer, J. M., & Sousa-Poza, A. (2015). Impacts of informal caregiving on caregiver employment, health, and family. Journal of Population Ageing, 8(3), 113–145.
Berecki-Gisolf, J., Lucke, J., Hockey, R., & Dobson, A. (2008). Transitions into informal caregiving and out of paid employment of women in their 50s. Social Science & Medicine, 67(1), 122–127.
Bevans, M. F., & Sternberg, E. M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA, 307(4), 398–403.
Bhaskaran, K., & Smeeth, L. (2014). What is the difference between missing completely at random and missing at random? International Journal of Epidemiology, 43(4), 1336–1339.
Brody, E. M., Litvin, S. J., Hoffman, C., & Kleban, M. H. (1992). Differential effects of daughters' marital status on their parent care experiences. The Gerontologist, 32(1), 58–67.
Burton, L. M., & Dilworth-Anderson, P. (1991). The intergenerational roles of aged black Americans. Marriage and Family Review, 16, 311–322.
Buyck, J. F., Bonnaud, S., Boumendil, A., Andrieu, S., Bonenfant, S., Goldberg, M., Zins, M., & Ankri, J. (2011). Informal caregiving and self-reported mental and physical health: Results from the Gazel cohort study. American Journal of Public Health, 101(10), 1971–1979.
Carmichael, F., & Charles, S. (2003). The opportunity costs of informal care: Does gender matter? Journal of Health Economics, 22(5), 781–803.
Centers for Disease Control and Prevention and The Merck Company Foundation. (2007). The state of aging and health in America 2007. Whitehouse Station: The Merck Company Foundation https://www.cdc.gov/aging/pdf/saha_2007.pdf. Accessed June 8, 2017.
Chappell, N. L., Dujela, C., & Smith, A. (2015). Caregiver well-being: Intersections of relationship and gender. Research on Aging, 37(6), 623–645.
Chari, A. V., Engberg, J., Ray, K. N., & Mehrotra, A. (2015). The opportunity costs of informal elder-care in the United States: New estimates from the American time use survey. Health Services Research, 50, 871–882. https://doi.org/10.1111/1475-6773.12238.
Chassin, L., Macy, J. T., Seo, D. C., Presson, C. C., & Sherman, S. J. (2010). The association between membership in the sandwich generation and health behaviors: A longitudinal study. Journal of Applied Developmental Psychology, 31(1), 38–46.
Cohen, S. A., Cook, S. K., Sando, T. A., Brown, M. J., & Longo, D. R. (2017). Socioeconomic and demographic disparities in caregiving intensity and quality of life in informal caregivers: A first look at the National Study of caregiving. Journal of Gerontological Nursing, 43(6), 17–24.
Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170–180. https://doi.org/10.1037/a0014564.
Costa, N., Derumeaux, H., Rapp, T., Garnault, V., Ferlicoq, L., Gillette, S., Andrieu, S., Vellas, B., Lamure, M., Grand, A., & Molinier, L. (2012). Methodological considerations in cost of illness studies on Alzheimer disease. Health Economics Review, 2(1), 18.
Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics and violence against women of color. Stanford Law Review., 43, 1241–1299.
Dahlberg, L., Demack, S., & Bambra, C. (2007). Age and gender of informal carers: A population-based study in the UK. Health & Social Care in the Community, 15(5), 439–445.
Deb, A., Thornton, J. D., Sambamoorthi, U., & Innes, K. (2017). Direct and indirect cost of managing Alzheimer’s disease and related dementias in the United States. Expert Review of Pharmacoeconomics & Outcomes Research, 17(2), 189–202.
DeFries, E. L., McGuire, L. C., Andresen, E. M., Brumback, B. A., & Anderson, L. A. (2009). Caregivers of older adults with cognitive impairment. Preventing Chronic Disease, 6(2), A46.
Dentinger, E., & Clarkberg, M. (2002). Informal caregiving and retirement timing among men and women gender and caregiving relationships in late midlife. Journal of Family Issues, 23(7), 857–879.
DePasquale, N., Davis, K. D., Zarit, S. H., Moen, P., Hammer, L. B., & Almeida, D. M. (2014). Combining formal and informal caregiving roles: The psychosocial implications of double-and triple-duty care. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(2), 201–211.
Dilworth-Anderson, P., Brummett, B. H., Goodwin, P., Williams, S. W., Williams, R. B., & Siegler, I. C. (2005). Effect of race on cultural justifications for caregiving. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(5), S257–S262.
Do, E. K., Cohen, S. A., & Brown, M. J. (2014). Socioeconomic and demographic factors modify the association between informal caregiving and health in the Sandwich generation. BMC Public Health, 14(1), 362.
Dwyer, J. W., & Miller, M. K. (1990). Differences in characteristics of the caregiving network by area of residence: Implications for primary caregiver stress and burden. Family Relations, 39, 27–37.
Edwards, V. J., Anderson, L. A., Thompson, W. W., & Deokar, A. J. (2017). Mental health differences between men and women caregivers, BRFSS 2009. Journal of Women & Aging, 29(5), 385-391.
Else-Quest, N. M., & Hyde, J. S. (2016). Intersectionality in quantitative psychological research: I. theoretical and epistemological issues. Psychology of Women Quarterly, 40(2), 155–170.
Evercare, National Alliance on Caregiving. Evercare study of Hispanic family caregiving in the US: findings from a national study; 2008. Available at: www.caregiving.org/data/Hispanic_Caregiver_Study_web_ENG_FINAL_11_04_08.pdf. Accessed December 17, 2017.
Fredman, L., Cauley, J. A., Satterfield, S., Simonsick, E., Spencer, S. M., Ayonayon, H. N., & Harris, T. B. (2008). Caregiving, mortality, and mobility decline: The health, aging, and body composition (health ABC) study. Archives of Internal Medicine, 168(19), 2154–2162.
Friedemann, M. L., & Buckwalter, K. C. (2014). Family caregiver role and burden related to gender and family relationships. Journal of Family Nursing, 20(3), 313–336.
Friedemann, M. L., Buckwalter, K. C., Newman, F. L., & Mauro, A. C. (2013). Patterns of caregiving of Cuban, other Hispanic, Caribbean black, and White elders in South Florida. Journal of Cross-Cultural Gerontology, 28(2), 137–152.
Gallagher-Thompson, D., Shurgot, G. R., Rider, K., Gray, H. L., McKibbin, C. L., Kraemer, H. C., Sephton, S. E., & Thompson, L. W. (2006). Ethnicity, stress, and cortisol function in Hispanic and non-Hispanic white women: A preliminary study of family dementia caregivers and noncaregivers. The American Journal of Geriatric Psychiatry, 14(4), 334–342.
Geronimus, A. T., Bound, J., Waidmann, T. A., Colen, C. G., & Steffick, D. (2001). Inequality in life expectancy, functional status, and active life expectancy across selected black and white populations in the United States. Demography, 38(2), 227–251.
Giesbrecht, M., Wolse, F., Crooks, V. A., & Stajduhar, K. (2015). Identifying socio-environmental factors that facilitate resilience among Canadian palliative family caregivers: A qualitative case study. Palliative and Supportive Care, 13(03), 555–565.
Glasgow, N. (2000). Rural/urban patterns of aging and caregiving in the United States. Journal of Family Issues, 21(5), 611–631.
Gray, H. L., Jimenez, D. E., Cucciare, M. A., Tong, H. Q., & Gallagher-Thompson, D. (2009). Ethnic differences in beliefs regarding Alzheimer disease among dementia family caregivers. The American Journal of Geriatric Psychiatry, 17(11), 925–933.
Hankivsky, O. (2012). Women’s health, men’s health, and gender and health: Implications of intersectionality. Social Science & Medicine, 74(11), 1712–1720.
Hankivsky, O., Cormier, R., & De Merich, D. (2009). Intersectionality: Moving women's health research and policy forward (p. 68). Vancouver: Women's Health Research Network.
Hebert, P. L., Sisk, J. E., & Howell, E. A. (2008). When does a difference become a disparity? Conceptualizing racial and ethnic disparities in health. Health Affairs, 27(2), 374–382.
Hoffman, G. J., Lee, J., & Mendez-Luck, C. A. (2012). Health behaviors among baby boomer informal caregivers. The Gerontologist, 52(2), 219–230.
Horowitz, A. (1985). Sons and daughters as caregivers to older parents: Differences in role performance and consequences. The Gerontologist, 25(6), 612–617.
Iyer, A., Sen, G., & Östlin, P. (2008). The intersections of gender and class in health status and health care. Global Public Health, 3(S1), 13–24.
Jackson, J. S., Antonucci, T. C., & Brown, E. (2004). A cultural lens on biopsychosocial models of aging. Advances in Cell Aging and Gerontology, 15, 221–241.
Jones, R. H. (2011). Bayesian information criterion for longitudinal and clustered data. Statistics in Medicine, 30(25), 3050–3056.
Jones, R. W., Romeo, R., Trigg, R., Knapp, M., Sato, A., King, D., Niecko, T., Lacey, L., & DADE Investigator Group. (2015). Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: The DADE study. Alzheimer's & Dementia, 11(3), 280–290.
Kahn, J. R., McGill, B. S., & Bianchi, S. M. (2011). Help to family and friends: Are there gender differences at older ages? Journal of Marriage and Family, 73(1), 77–92.
Kasper, J. D., & Freedman, V. A. (2014). Findings from the 1st round of the National Health and aging trends study (NHATS): Introduction to a special issue. The Journals of Gerontology: Series B, 69(Suppl 1), S1–S7.
Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642–1649.
Keith, C. (1995). Family caregiving systems: Models, resources, and values. Journal of Marriage and the Family, 57, 179–190.
Kim, S., & Knight, B. G. (2018). Caregiving subgroups differences in the associations between the resilience resources and life satisfaction. Journal of Applied Gerontology, 37(12), 1540-1563.
Laditka, J. N., & Laditka, S. B. (2001). Adult children helping older parents variations in likelihood and hours by gender, race, and family role. Research on Aging, 23(4), 429–456.
Langa, K. M., Chernew, M. E., Kabeto, M. U., Regula Herzog, A., Beth Ofstedal, M., Willis, R. J., Wallace, R. B., Mucha, L. M., Straus, W. L., & Fendrick, A. M. (2001). National estimates of the quantity and cost of informal caregiving for the elderly with dementia. Journal of General Internal Medicine, 16(11), 770–778.
Lee, Y., & Tang, F. (2015). More caregiving, less working: Caregiving roles and gender difference. Journal of Applied Gerontology, 34(4), 465–483.
Leggett, A., Polenick, C. A., Maust, D. T., & Kales, H. C. (2018). “What hath night to do with sleep?”: The caregiving context and dementia caregivers’ nighttime awakenings. Clinical Gerontologist, 41(2), 158–166.
Leopold, T., Raab, M., & Engelhardt, H. (2014). The transition to parent care: Costs, commitments, and caregiver selection among children. Journal of Marriage and Family, 76(2), 300–318.
McCann, J. J., Hebert, L. E., Beckett, L. A., Morris, M. C., Scherr, P. A., & Evans, D. A. (2000). Comparison of informal caregiving by black and white older adults in a community population. Journal of the American Geriatrics Society, 48(12), 1612–1617.
Mendez-Luck, C. A., & Anthony, K. P. (2016). Marianismo and caregiving role beliefs among US-born and immigrant Mexican women. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(5), 926–935.
Mendez-Luck, C. A., Geldhof, J. G., Anthony, K. P., Steers, W. N., Mangione, C. M., & Hays, R. D. (2016). Orientation to the caregiver role among Latinas of Mexican-origin. The Gerontologist, 56, e99–e108.
Miyawaki, C. E. (2016). Caregiving practice patterns of Asian, Hispanic, and non-Hispanic white American family caregivers of older adults across generations. Journal of Cross-Cultural Gerontology, 31(1), 35–55.
Mohamed, S., Rosenheck, R., Lyketsos, C. G., & Schneider, L. S. (2010). Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. The American Journal of Geriatric Psychiatry, 18(10), 917-927.
Montaquila, J., Freedman, V. A., Edwards, B., & Kasper, J. D. (2012). National Health and aging trends study round 1 sample design and selection. Baltimore: NHATS technical paper #1 Accessed July 31, 2018. Available at: www.nhats.org.
National Alliance for Caregiving. Caregiving in the US; 2009. Available at: www.caregiving.org/data/Caregiving_in_the_US_2009_full_report. pdf. Accessed September 27, 2017.
National Alliance for Caregiving, AARP. Caregiving in the US executive summary; 2005. Accessed September 22, 2017. Available at: http://assets.aarp.org/rgcenter/il/us_caregiving_1.pdf.
National Alliance for Caregiving, AARP. Caregiving in the US: A focused look at the ethnicity of those caring for someone age 50 or older executive summary; 2009. Accessed September 27, 2017. Available at: http://assets.aarp.org/rgcenter/il/caregiving_09_es50ethnic.pdf.
Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., & Donelan, K. (2001). The experiences and challenges of informal caregivers common themes and differences among whites, blacks, and Hispanics. The Gerontologist, 41(6), 733–741.
Navaie-Waliser, M., Spriggs, A., & Feldman, P. H. (2002). Informal caregiving: Differential experiences by gender. Medical Care, 40(12), 1249–1259.
O'Sullivan, A. (2015). Pulled from all sides: The sandwich generation at work. Work, 50(3), 491–494.
Peek, M. K., Coward, R. T., & Peek, C. W. (2000). Race, aging, and care: Can differences in family and household structure account for race variations in informal care? Research on Aging, 22(2), 117–142.
Pinquart, M., & Sörensen, S. (2006). Gender differences in caregiver stressors, social resources, and health: An updated meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(1), P33–P45.
Rogerson, P. A., & Kim, D. (2005). Population distribution and redistribution of the baby-boom cohort in the United States: Recent trends and implications. Proceedings of the National Academy of Sciences, 102(43), 15319–15324.
Rote, S. M., & Moon, H. (2016). Racial/ethnic differences in caregiving frequency: Does immigrant status matter?. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, gbw106.
Rubin, R. M., & White-Means, S. I. (2009). Informal caregiving: Dilemmas of sandwiched caregivers. Journal of Family and Economic Issues, 30(3), 252–267.
Sabik, N. J. (2016). Digging deeper: Research practices and recommendations for exploring intersectionality and social and cultural influences on personality, identity, and well-being. In Feminist Perspectives on Building a Better Psychological Science of Gender (pp. 143–160). Springer international publishing.
Saunders, M. M. (2008). Factors associated with caregiver burden in heart failure family caregivers. Western Journal of Nursing Research, 30(8), 943–959.
Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The caregiver health effects study. Journal of the American Medical Association, 282(23), 2215–2219.
Schulz, A. J., & Mullings, L. (2006). Gender, race, class, and health: Intersectional approaches. San Francisco: Jossey-Bass.
Spillers, R. L., Wellisch, D. K., Kim, Y., Matthews, A., & Baker, F. (2008). Family caregivers and guilt in the context of cancer care. Psychosomatics, 49(6), 511–519.
Stack, B., & Burton, L. M. (1993). Kinscripts. Journal of Comparative Family Studies, 24(2), 157–170.
Talley, R. C., & Crews, J. E. (2007). Framing the public health of caregiving. American Journal of Public Health, 97(2), 224–228.
Tatangelo, G., McCabe, M., Macleod, A., & You, E. (2018). “I just don’t focus on my needs.” The unmet health needs of partner and offspring caregivers of people with dementia: A qualitative study. International Journal of Nursing Studies, 77, 8–14.
Tran, T. V. (1997). Ethnicity, gender and social stress among three groups of elderly Hispanics. Journal of Cross-Cultural Gerontology, 12(4), 341–356.
Trivedi, R., Beaver, K., Bouldin, E. D., Eugenio, E., Zeliadt, S. B., Nelson, K., Rosland, A. M., Szarka, J. G., & Piette, J. D. (2014). Characteristics and well-being of informal caregivers: Results from a nationally-representative US survey. Chronic Illness, 10(3), 167–179.
Versey, H. S. (2017). Caregiving and Women's health: Toward an intersectional approach. Women's Health Issues, 27(2), 117–120.
Warner, D. F., & Brown, T. H. (2011). Understanding how race/ethnicity and gender define age-trajectories of disability: An intersectionality approach. Social Science & Medicine, 72(8), 1236–1248.
Williams, A., Sethi, B., Duggleby, W., Ploeg, J., Markle-Reid, M., Peacock, S., & Ghosh, S. (2016). A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective. International Journal for Equity in Health, 15(1), 40.
Wolff, J. L., Spillman, B. C., Freedman, V. A., & Kasper, J. D. (2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Internal Medicine, 176(3), 372–379.
Zhu, C. W., Torgan, R., Scarmeas, N., Albert, M., Brandt, J., Blacker, D., Sano, M., & Stern, Y. (2008). Home health and informal care utilization and costs over time in Alzheimer's disease. Home Health Care Services Quarterly, 27(1), 1–20.
Conflict of Interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Cohen, S.A., Sabik, N.J., Cook, S.K. et al. Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers. J Cross Cult Gerontol 34, 245–263 (2019). https://doi.org/10.1007/s10823-019-09381-9
- Informal caregiving
- Older adults
- Health inequalties
- Social determinants