Demographic and socio-economic influences on community-based care and caregivers of people with dementia in China

Background: Dementia is a major public health challenge and China has the largest population with dementia in the world. However, dementia care and caregivers for Chinese are less investigated. Objectives and design: To evaluate demographic and socio-economic influences on dementia care, management patterns and caregiver burden in a household community-dwelling-based survey, using participants' care receipts and Zarit scale. Setting and participants: Rural and urban communities across six provinces of China comprising 4837 residents aged >= 60 years, in whom 398 had dementia and 1312 non-dementia diseases. Results: People with dementia were less likely to receive care if they were living in rural compared to urban areas (Odd ratio (OR) = 0.20; 95% CI: 0.10-0.41), having education level below compared to above secondary school (OR = 0.24; 95% CI: 0.08-0.70), manual labourer compared to non-manual workers (OR = 0.27; 95% CI: 0.13-0.55), having personal annual income below RMB 10,000 yuan (1000) pound compared to above (OR = 0.37; 95% CI: 0.13-0.74) or having four or more than compared to less four children (OR = 0.52; 95% CI: 0.27-1.00). Caregivers for dementia compared with those for non-dementia diseases were younger and more likely to be patients' children or children in-law, had lower education and spent more caring time. Caregiver burden increased with low education, cutback on work and caring for patients who were younger or living in rural areas, and this caregiver burden was three-fold greater than that for non-dementia diseases. Conclusions: There are a number of inequalities in dementia care and caregiver burden in China. Reducing the socio-economic gap and increasing education may improve community care for people with dementia and preserve caregivers' well-being.