The Excessive Burden of Low SES Caregivers: Evidence from Stroke Survivors Through CHARLS Data (2011-2018)

OBJECTIVES: According to the World Stroke Organization, stroke is the third leading cause of disability worldwide; furthermore, around 26% of stroke survivors after surgical interventions require long-term care after six months. Thus, sudden life-threatening events such as acute stroke cause excessive burdens to the patients and the families, especially for the low socioeconomic status (SES) counterparts, as they are not eligible for effective consumption-smoothing preparedness through savings and high-premium insurance plans. Therefore, we aim to identify the caregiver's burden and the difference between high- and low-SES families in developing areas in China due to the unpredictability of first stroke occurrence.

METHODS: We cleaned the publicly available China Health and Retirement Longitudinal Study (CHARLS) database, and identified 1,693 individuals who survived their first stroke for at least two waves (four years) and have a constant family member as a caregiver. "CES-D-10" (Center of Epidemiologic Studies Depression Scale, 10-item Version) as the mental burden indicator with three severity levels alongside the changes in family income.

Through OLS for income differences between waves and the Ordered Probit Model for mental status measurement, controlling low-SES features (an annual income less than 12,000 RMB under 2019 price level and below low-secondary education, accounting for 43.21% of observations), and a list of characteristic features to account for the differences.

RESULTS: Income difference is significantly greater among the low-SES status population (RMB -5,210, r<0.01) in two years but returning to the original standard (RMB 5,988, r<0.01) after two more years compared to high-SES counterparts (both insignificant). The mental status showed a significant positive tendency to exacerbate on the caregiver's end in two years (OR=1.17, r=0.02) but insignificantly changed after another two (OR=0.82, r=0.37).

CONCLUSIONS: Stroke events might pose a long-term mental burden on the low-SES population, with an economic burden that requires four years to ease compared to their high-SES counterparts.