Patterns of Lifestyle Risk Behaviors for Cardiovascular Disease in Family Caregivers: A Latent Class Analysis

Soojung Ahn^1*Elisa H Son²Mulubrhan F Mogos³James M Muchira³Ying Sheng³Chorong Park⁴Lena J Lee²

• ¹Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States
• ²National Institutes of Health Clinical Center, Bethesda, United States
• ³School of Nursing, Vanderbilt University, Nashville, Tennessee, United States
• ⁴College of Nursing, Seoul National University, Seoul, Republic of Korea

Lifestyle risk behaviors for cardiovascular disease (CVD) often co-occur. However, little is known about their co-occurrence patterns among family caregivers, a high-risk population for CVD. This study aimed to identify distinct latent classes of lifestyle risk behaviors for CVD among caregivers and to examine socio-demographic, health-related, and caregiving characteristics associated with membership in these latent classes. We conducted a cross-sectional secondary data analysis of the 2019 Health Information National Trends Survey 5 Cycle 3, involving 643 unpaid family caregivers in the United States. The lifestyle risk behaviors for CVD included current cigarette use, current alcohol consumption, low physical activity, prolonged sedentary time, low fruit intake, and low vegetable intake, as defined by established guidelines. We performed latent class analysis to identify unobserved subgroups based on these multiple lifestyle risk behaviors. Subsequently, we conducted multinomial logistic regression to investigate socio-demographic, health-related, and caregiving characteristics associated with latent class membership. The majority of participants were females (55.3%) and non-Hispanic white (57.1%), with a mean age of 55±16 years. Three distinct classes were identified: Class 1 (Physically active caregivers, 17.1%), Class 2 (Physically inactive, healthy eaters, 18.8%), and Class 3 (Physically inactive, unhealthy eaters, 64.1%). In unadjusted models, older caregivers (≥65 years) were more likely to belong to Class 2, relative to Class 1, compared to those aged 18-49 years. Caregivers with perceived financial difficulties, psychological distress, low self-efficacy in health management, and poor sleep quality were more likely to belong to Class 3, rather than Class 1, compared to their counterparts. Additionally, dementia care and caregiving ≥ 20 hours/week were significantly associated with Class 3 membership. In the adjusted model, psychological distress remained significant. Caregivers reporting psychological distress were more likely to belong to Class 3 rather than Class 1, compared to those without psychological distress. Our findings reveal the presence of subgroups of caregivers with unique patterns of lifestyle risk behaviors, with most not meeting the recommended levels of health behaviors. Future studies should consider these co-occurring patterns along with the key factors associated with higher-risk lifestyle behaviors patterns when developing interventions to promote caregivers’ cardiovascular health.