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From the Department of Neurology (Drs. Hickenbottom and Kutcher), Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES) (Drs. Fendrick and Katz, and M.U. Kabeto), Division of General Internal Medicine, Department of Internal Medicine (Drs. Fendrick, Katz, and Langa), and Institute for Social Research (Drs. Katz and Langa), University of Michigan; and VA Center for Practice Management and Outcomes Research (Drs. Katz and Langa), Ann Arbor, MI.
Address correspondence and reprint requests to Susan L. Hickenbottom, MD, MS, Clinical Assistant Professor, Director, Stroke Program, Department of Neurology, University of Michigan Health System, TC 1914/0316, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; e-mail: shickenb{at}umich.edu
Background: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients.
Objective: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke.
Methods: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated.
Results: Of 7,443 respondents, 656 (8.8%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke ± SRHP (p < 0.01). Using the median 1999 home health aide wage ($8.20/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from $3,500 to $8,200. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to $6.1 billion for stroke-related informal caregiving in the United States.
Conclusions: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.
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