Participation in a US community-based cardiovascular health study: investigating nonrandom selection effects related to employment, perceived stress, work-related stress, and family caregiving

Abstract

Background Participation in health studies may be inversely associated with employment and stress. We investigated whether employment, perceived stress, work-related stress, and family caregiving were related to participation in a longitudinal US community-based health study of black and white men and women aged ≥45 years. Methods Prevalence ratios and confidence intervals were estimated for completion of the second-stage (S2) of a two-stage enrollment process by employment (status, type), and stress (perceived stress, work-related stress, caregiving), adjusting for age, sex, race, region, income, and education. Eligibility and consent for a follow-up occupational survey was similarly evaluated. Results Wage- but not self-employed participants were less likely than the unemployed to complete S2. Among the employed, S2 completion did not vary by stress; however, family caregivers with a short time burden of care (<2-hours/day) were more likely to complete S2, compared to non-caregivers. Eligibility and participation in the follow-up occupational survey was higher among those employed (versus unemployed) at enrollment, but was not associated with enrollment stress levels. Conclusions Limited evidence of selection bias was seen by employment and stress within a large US community-based cohort, but findings suggest the need for enrollment procedures to consider possible barriers to participation among wage-employed individuals.

The Complexities of Family Caregiving at Work: A Mixed-Methods Study

“…Since the 1980s, a number of studies have found that the multiple, competing demands of employment and family caregiving often impede one or both of these roles (Barling, MacEwen, Kelloway, & Higginbottom, 1994;Scharlach, 1994;Scharlach, Sobel, & Roberts, 1991;Schulz & Martire, 2009;Stephens & Frank, 2009;Stone & Short, 1990;Thrasher, Zabel, Wynne, & Baltes, 2015;Wagner, 2006). Several recent studies have continued to shed light on the effects of employment on care-related stress and work (Carr et al, 2018;DePasquale, Polenick, Davis, Berkman, & Cabot, 2018;DePasquale, Polenick, Davis, Moen, et al, 2017;Fekete, Siegrist, Tough, & Brinkhof, 2018;Lerner et al, 2017;MacDonald, Fujishiro, Howard, Landsbergis, & Hein, 2017;Oldenkamp et al, 2018;Paulson, Bassett, Kitsmiller, Luther, & Conner, 2017). Family caregiving can also affect employers.…”

Duration of employment within occupations and incident stroke in a US general population cohort 45 years of age or older (REGARDS study)

“…First, we only focused on participants with reported longest‐held jobs, not their entire occupational history. Our sample within the REGARDS cohort is likely biased toward self‐employed individuals as reported by Macdonald et al 53 Second, in the within‐occupation analysis, some occupations had small sample sizes which limit our level of confidence in their estimates. The small sample sizes also prevented us to perform the adjustment in some occupation groups which we noted in the footnotes and impact the interpretation of the results in those groups.…”