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Neighborhood Characteristics Moderate Effects of Caregiving on Glucose Functioning

From the Department of Psychiatry and Behavioral Medicine, Duke University Medical Center (B.H.B., I.C.S., J.C.B., R.S.S., M.N.F., R.B.W.); the Center for Urban and Regional Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (W.M.R.); and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington (P.P.V.)

Address correspondence and reprint requests to Beverly H. Brummett, Box 2969 Duke University Medical Center, Durham, North Carolina, 27710. E-mail: brummett{at}duke.edu

Objective: Adverse neighborhood environments and caregiving for a relative with dementia are both stressors that have been associated with poor health. The present study examined the extent to which three self-report measures of neighborhood characteristics interact with caregiving status (caregiver versus noncaregiver) to modify an important stress related health outcome: plasma glucose.

Methods: The study sample consisted of 147 community recruited caregivers and 147 participants who did not have caregiving responsibilities. We hypothesized that negative neighborhood characteristics would magnify effects of caregiving on plasma glucose levels. Regression analyses were conducted to examine the interaction of three neighborhood characteristic measures with caregiving status in predicting fasting plasma glucose (FPG) and glycosylated hemoglobin concentration (HbA1c), with control for age, race, gender, relation to care recipient (spouse or relative), body mass index, income, and education.

Results: Of the three neighborhood measures, the one reflecting crime concerns significantly moderated the effect of caregiving on FPG (p < .002) and HbA1c (p < .001). For participants with better neighborhood characteristics, caregivers and noncaregivers were similar with respect to indicators of glucose metabolism; however, for participants with worse neighborhood characteristics, caregivers had higher levels of FPG and HbA1c, as compared with noncaregivers.

Conclusions: Poor health outcomes, such as impaired glucose control, may be found among caregivers who fear neighborhood crime.

Key Words: caregiving • glucose • neighborhood characteristics

Abbreviations: FPG = fasting plasma glucose; HbA1c = glycosylated hemoglobin concentration; SES = socioeconomic status; BMI = body mass index; STAI = Spielberger Trait Anxiety Scale; CES-D = Center for Epidemiologic Studies of Depression Scale; PSQI = Pittsburgh Sleep Quality Index; ISEL = Interpersonal Support Evaluation List.

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