Evidence of Spillover of Illness among Household Members

Abstract

Background/Objectives: The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members’ health-related quality of life. Methods: Medical Expenditures Panel Survey (MEPS) data from 2000–2003 were analyzed using multivariable regression to identify spillover of household members’ chronic conditions onto individuals’ health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). Results: Controlling for an individual’s own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64–0.79), respiratory (0.85; 0.75–0.97), and musculoskeletal (0.83; 0.75–0.93) conditions among adults and with mental (0.72; 0.62–0.82) and respiratory (0.80; 0.81–0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults’ mental (0.79; 0.65–0.97), nervous/sensory system (0.76; 0.61–0.96), and musculoskeletal (0.78; 0.65–0.95) conditions and children’s mental conditions (0.64; 0.48–0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. Conclusions: Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.

How Illness Affects Family Members: A Qualitative Interview Survey

“…[26] This study describes how spillover effects extend beyond those associated with caregiving, and includes effects of simply being related to someone who is ill; these effects have been quantified previously but not described. [2,11] Such is the case of children with ill parents who are not caretakers but are nevertheless affected by the illness. Moreover, our results confirm that spillover effects are quite nuanced, mixing burden with purpose, such as the mother whose life becomes defined by taking care of her child.…”

“…[1,2] These “spillover” effects of illness affect many aspects of family members’ lives, from physical and emotional health to quality of life and well-being. [3–6] Quality of life and well-being are subjectively-assessed constructs that may include aspects of health, functioning, capabilities, security, spirituality and other domains depending on the context.…”

“…[22–24] Though useful in documenting caregiver experiences, these measures focus primarily on caregiving itself and risk excluding the entirety of the family’s experience including non-caregiving effects and non-caregiving family members, that are noted to exist but may not be fully recognized. [1,2,11,25] …”

Variation in the Spillover Effects of Illness on Parents, Spouses, and Children of the Chronically Ill

“…One important source of variability in the magnitude of spillover effects may be family relationship type [6]. Previous research has shown that illness may impact family members differently, depending on the nature of their relationship with the ill individual [6, 21], but evidence on the subject is limited.…”

“…Previous research has shown that illness may impact family members differently, depending on the nature of their relationship with the ill individual [6, 21], but evidence on the subject is limited. To date, most studies on spillover have looked at the impact of illness on caregivers in general [2, 3, 10-13, 17, 18, 22] or on specific relationship types, including spouses [7] and parents [9, 14, 16, 19], using a variety of measurement tools.…”