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January 02, 2018; 90 (1) Article

Sex disparities in access to caregiving in Parkinson disease

Nabila Dahodwala, Krunal Shah, Ying He, Samuel S. Wu, Peter Schmidt, Fernando Cubillos, Allison W. Willis
First published December 1, 2017, DOI: https://doi.org/10.1212/WNL.0000000000004764
Nabila Dahodwala
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Krunal Shah
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Ying He
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Samuel S. Wu
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Peter Schmidt
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Fernando Cubillos
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Allison W. Willis
From the Department of Neurology (N.D., K.S., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; Department of Biostatistics (S.S.W.), University of Florida, Gainesville; and National Parkinson Foundation Inc (P.S., F.C.), Miami, FL.
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Citation
Sex disparities in access to caregiving in Parkinson disease
Nabila Dahodwala, Krunal Shah, Ying He, Samuel S. Wu, Peter Schmidt, Fernando Cubillos, Allison W. Willis
Neurology Jan 2018, 90 (1) e48-e54; DOI: 10.1212/WNL.0000000000004764

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Abstract

Objective To compare access to caregiving between men and women with Parkinson disease (PD).

Methods This was a cross-sectional and longitudinal study among participants with PD enrolled in the National Parkinson Foundation Parkinson's Outcomes Project from 2009 to 2014 at 21 international sites. The primary outcome measures were presence of a caregiver at the baseline visit, caregiver burden as measured by the Multidimensional Caregiver Strain Index (MCSI) at baseline, and time to first paid caregiver.

Results A total of 7,209 participants (63% men, 37% women) with PD were evaluated. Men had a mean age of 66.0 (SD 9.8) years, and women had a mean age of 66.9 (SD 9.7) years. More men than women had a caregiver (88.4% vs 79.4%, p < 0.0001). Caregivers of men reported greater strain than those of women (MCSI score 19.9 vs 16.4, p < 0.0001). These differences persisted after controlling for age, disease stage, number of comorbidities, cognitive and mobility measures, and health-related quality of life. In addition, the odds of caregiver accompaniment at baseline visit were lower for women compared to men (odds ratio 0.76, 95% confidence interval [CI] 0.67–0.86), and women had a faster rate to using a paid caregiver than men (hazard ratio 1.76, 95% CI 1.35–2.28) after controlling for potential confounders.

Conclusions Informal caregiving resources are lower for women than men with PD, despite the finding that their caregivers report less strain than those of men. In addition, women are more likely to use formal, paid caregivers. Strategies to improve access to caregiving, particularly for women, are needed.

Glossary

H & Y=
Hoehn & Yahr;
MCSI=
Multidimensional Caregiver Strain Index;
NPF=
National Parkinson Foundation;
PD=
Parkinson disease;
PDQ-39=
Parkinson's Disease Questionnaire-39;
POP=
Parkinson's Outcomes Project;
TUG=
Timed Up and Go

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received April 7, 2017.
  • Accepted in final form September 22, 2017.
  • Copyright © 2017 American Academy of Neurology
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