Health-related quality of life in caregivers of community-dwelling individuals with disabilities or chronic conditions. A gender-differentiated analysis in a cross-sectional study
Authors: Rico-Blázquez Milagros , Quesada-Cubo Víctor , Polentinos-Castro Elena , Sánchez-Ruano Raquel , Rayo-Gómez M Ángeles , del Cura-González Isabel ,   CuidaCare Group, Rico-Blázquez Milagros , Almena-Martín Rosario , Almodovar-López Ángeles , Alonso-Arcas Julia , Álvarez-Navarro Elvira , Álvarez-Santos Henar , Andrés-Alonso Begoña , Antolín-Díaz Virginia , Araujo-Calvo Mercedes , Ayuso-Gil Encarnación , Barbero-Macías Cynthia A. , Bermejo-Mayoral Inés , Berninches-Heredero Ana , Botanes-Peñafiel Lourdes , Cámara-González Lorena , Careaga-González Isabel , de-Casas-Albendea Sergio , Castilla-Álvarez Carmen , Castro-Sánchez Belén , Castro-Torrado Noelia , Clemente-del-Castillo María J. , Dávila-Moriña Pilar , Díaz-de-Espada-León Juana , Domínguez-González Analía , Domínguez-Pérez Lorena , Domínguez-Puebla Dolores , Escribano-Zaera Mónica , Escudero-Muñoz Luisa , Fernández-Arnaldo Raquel , Fernández-del-Campo-Coca Teresa , Fernández-Ortega Mercedes , Fernández-Rodríguez Rafaela , García-Campo Virginia , García-del-Río Isabel , García-Garrudo María J. , García-Gómez-de-Cardiñanos Elena , García-Ruíz Juan , García-San Petra , Geanini-Torres Jorge , Gómez-Quevedo Rosa , Gómez-Robledo Eva , Gómez-Pesquera Carmen , González-Fernández Begoña , González-Valls Aranzazu , Harris-de-la-Vega Natalie , Herrero-Yusta Susana , de-la-Iglesia-Moreno Sonia , Jiménez-Maillo Silvia , Juárez-Zapatero Luisa , Juez-Pimienta Raquel , Lara-Bueno Francisca , Lasala-Raso Pilar , Letón-Gutiérrez Lucía , Leza-Leza Margarita , López-del-Cid Raquel , López-Kölmer Laura , Lozano-Fernández Paz , López-Serrano Elisa , Martín-Ávila Elena , Martín-Martín María , Martín-Martínez Sara , Martínez-Arroyo Anunciación , Martínez-Palomo Carmen , Martínez-Ruíz Cristina , Martínez-Zafra Pilar , Mateo-Madurga Alicia , Méndez-Junco Natalia , Minguito-Lobos Antonia , Molina-Gómez Paloma , Moreno-Collado Marina , Moreno-Moreno Ana B. , Olmos-Sancho Cristina , Peláez-Toré Remedios , Pérez-Barrios Raquel , Pérez-García Pérez-Barrios , Pulido-López Esmeralda , Ramírez-Puerta Ana B. , del Rey-Moya Luz , Rivera-Álvarez Araceli , Rodrigo-Rodrigo Paz , Ruiz-Martín María N. , Serna-Urnicia AnaI , Sidera-Jiménez Josefa , Tornay-Muñoz Encarnación , Villanova-Cuadra Laura , Villanueva-Alameda Isabel , Villanueva-Sanz Cristina , Villares-Motino Emiliana 
Published: March 2022

Abstract
Background
Most care for people with chronic or disabling conditions living in the community is provided in the family context, and this care is traditionally provided by women. Providing informal care has a negative impact on caregivers’ quality of life, which adds to existing health inequalities associated with gender. The aim of this study was to analyze factors associated with the health-related quality of life of caregivers and to determine their differences in a gender-differentiated analysis.

Methods
An observational, cross-sectional, multicenter study was conducted in primary healthcare. A total of 218 caregivers aged 65 years or older were included, all of whom assumed the primary responsibility for caring for people with disabling conditions for at least 6 months per year and agreed to participate in the CuidaCare study. The dependent variable was health-related quality of life, assessed with the EQ-5D. The explanatory variables tested were grouped into sociodemographic variables, subjective burden, caregiving role, social support and variables related to the dependent person. The associations between these variables and health-related quality of life were estimated by fitting robust linear regression models. Separate analyses were conducted for women and men.

Results
A total of 72.8% of the sample were women, and 27.2% were men. The mean score on the EQ-5D for female caregivers was 0.64 (0.31); for male caregivers, it was 0.79 (0.23). There were differences by gender in the frequency of reported problems in the dimensions of pain/comfort and anxiety/depression. The variables that were associated with quality of life also differed. Having a positive depression screening was negatively associated with quality of life for both genders: -0.31 points (95% CI: -0.47; -0.15) for female caregivers and -0.48 points (95% CI: -0.92; -0.03) for male caregivers. Perceived burden was associated with quality of life in the adjusted model for women (-0.12 points; 95% CI: -0.19; -0.06), and domestic help was associated in the adjusted model for male caregivers (-0.12 points; 95% CI: -0.19; -0.05).

Conclusions
Gender differences are present in informal caregiving. The impact of providing informal care is different for male and female caregivers, and so are the factors that affect their perceived quality of life. It could be useful it incorporates a gender perspective in the design of nursing support interventions for caregivers to individualize care and improve the quality of life of caregivers.

Trial registration
NCT 01478295 [https://ClinicalTrials.gov]. 23/11/2011.