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Open Access Research article

Socioeconomic and demographic factors modify the association between informal caregiving and health in the Sandwich Generation

Elizabeth K Do13, Steven A Cohen2* and Monique J Brown2

Author Affiliations

1 Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA

2 Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, 830 East Main Street- 8th Floor, Richmond, Virginia 23298, USA

3 Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA

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BMC Public Health 2014, 14:362  doi:10.1186/1471-2458-14-362

Published: 15 April 2014



Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the “sandwich generation”, providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors.


We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity.


The association between informal caregiving and health varied by membership in the “sandwich generation,” income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]), but not in those without children (OR = 1.01, 95% CI [0.97, 1.05]). Associations were strongest in those earning $50,000-$75,000 annually, but these income-dependent associations varied by race/ethnicity. In Whites with two or more children, the strongest associations between caregiving and health occurred in lower income individuals. These trends were not observed for Whites without children.


Our findings suggest that the added burden of caregiving for both children and elderly relatives may be impacted by income and race/ethnicity. These differences should be considered when developing culturally appropriate interventions to improve caregiver health and maintain this vital component of the US health care system.

Informal caregiving; Older population; Race/ethnicity; Income; Children