Socioeconomic Disparities in Caregiver Burden Among Families of Older Patients With Cancer

Importance Population aging and rising cancer burden in low- and middle-income countries have intensified reliance on family caregivers, yet evidence on socioeconomic disparities in caregiving burden remains scarce. Objective To quantify multidimensional caregiving burden, psychological distress, and economic burden, as well as identify risk factors, with a focus on the impact of socioeconomic disparities among family caregivers of older patients with cancer in China. Design, Setting, and Participants This multicenter cross-sectional study recruited 6786 patient-caregiver dyads from 22 hospitals across 14 Chinese provinces between August 2022 and August 2023. Patients were 60 years or older with cancer; caregivers were family members or cohabiting partners 18 years or older who provided 50% or more daily care for 30 or more days. Data collection included sociodemographics, health assessments, caregiving details, expenditures, and clinical records. Exposures Socioeconomic status (SES), categorized into 4 levels based on education and household income. Main Outcomes and Measures Caregiving burden (measured by the Caregiver Reaction Assessment across 5 domains), psychological distress (measured by the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 scales), and economic burden (direct caregiving expenditure and income loss). Results Of the 6786 patient-caregiver dyads enrolled, the mean (SD) age of patients was 69.2 (6.1) years and 4128 (60.8%) were male, while the mean (SD) age of family caregivers was 53.8 (12.6) years and 3040 (44.8%) were male. Caregivers reported the following mean (SD) scores on a 5-point scale of Caregiver Reaction Assessment: health burden, 2.02 (0.69); scheduling burden, 2.64 (0.72); financial pressure, 3.03 (0.74); lack of family support, 2.09 (0.56); and self-esteem, 2.39 (0.42). Lower SES was independently associated with elevated burden across domains of health problems (β coefficient, −0.07; 95% CI, −0.10 to −0.04; P < .001), self-esteem (β coefficient, −0.15; −0.18 to −0.12; P < .001), disrupted schedule (β coefficient, −0.07; 95% CI, −0.11 to −0.03; P < .001), financial pressure (β coefficient, −0.14; 95% CI, −0.17 to −0.11; P < .001), and lack of family support (β coefficient, −0.14; 95% CI, −0.17 to −0.11; P < .001). Caregivers with health problems, insufficient sleep, longer care periods, lack of cocaregivers, limited nursing skills, and being employed experienced higher burden. Caregivers with the lowest level of SES faced elevated risks of anxiety (odds ratio, 1.37; 95% CI, 1.15-1.62) and depression (odds ratio, 1.71; 95% CI, 1.41-2.05) compared to caregivers with the highest level of SES. Subgroup analyses revealed that spouses reported higher health and financial burden, while higher-educated adult child caregivers were at greater risks for psychological distress. Caregivers covered 57.4% of total expenditure for older patients with cancer, and 31.7% of caregivers’ expenses for patients in the past year had exceeded their annual household income. Paradoxically, caregivers with higher SES experienced greater employment-related costs due to prolonged work absences. Conclusions and Relevance Results of this cross-sectional study show that socioeconomic disparities profoundly shape caregiving burden, psychological distress, and economic burden faced by family caregivers of older patients with cancer. Policy interventions, targeted subsidies for families with low SES, workplace protections for employed caregivers, and integrated community support are urgently needed to address inequities and strengthen eldercare systems amid rapid population aging.