Sandwich caregiving and midlife women's health: An examination of racial disparities

• Published date: 01 December 2024
• Author: Qi Li
• Date: 01 December 2024
• DOI: http://doi.org/10.1111/fare.13083

RESEARCH

Sandwich caregiving and midlife women’s health: An

examination of racial disparities

Qi Li

University of Nebraska–Lincoln, Lincoln, NE

Correspondence

Qi Li, 705 Oldfather Hall, Lincoln, NE 68588,

USA.

Email: qli32@unl.edu

Abstract

Objective: This research project aims to (a) investigate the

association between sandwich caregiving and midlife

women’s health and (b) ask how this relationship differs

by race.

Background: Although researchers consistently find that

physical health declines substantially during midlife for

women, much about what produces this trend is

unexplored. One notable gap in prior literature is the

impact of simultaneously providing care to both aging par-

ents and young children (i.e., sandwich caregiving) on the

health and well-being of midlife women.

Method: This study analyzes six consecutive waves of

nationally representative data from the National Longitu-

dinal Survey of Youth 1979 (NLSY79) between 2008 and

2018 with growth curve models.

Results: The analysis illustrates that sandwich caregiving

does not have a significant relationship with self-reported

physical health among White and Black mothers but has a

negative association with fair or poor self-rated physical

health among Hispanic mothers.

Conclusion: This study contributes to previous scholarship

by specifying the heterogeneous consequences of sandwich

caregiving for the health and well-being of White, Black,

and Hispanic women during midlife. Moreover, this work

highlights the importance of exploring the complex impli-

cations of sandwich caregiving, as more and more midlife

adults begin to provide care to dual generations.

Implications: This study underscores the relevance of the

life course perspective and the stress process model in

understanding sandwich caregiving. Furthermore, my

findings emphasize the significance of the family as a

social institution in shaping social inequality and the need

Received: 20 July 2023 Revised: 10 April 2024 Accepted: 13 June 2024

DOI: 10.1111/fare.13083

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and

reproduction in any medium, provided the original work is properly cited.

© 2024 The Author(s). Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2024;73:3291–3308. wileyonlinelibrary.com/journal/fare 3291

for race-specific interventions to mitigate the adverse

health outcomes of sandwich caregiving.

KEYWORDS

family caregiving, midlife women, physical health, racial disparities,

sandwich generation

Midlife is a key life stage for adults in the United States, as it is when physical health declines con-

siderably. For example, the Centers for Disease Control and Prevention (2017) indicated that the

majority of new diagnoses for diabetes take place when patients are between the ages of 45 and

64 years. Moreover, in the case of obesity, the prevalence is the highest at 43% for adults aged 40 to

59 years, compared to 36% for younger adults aged 20 to 39 years, and 41% for adults who are

60 years and older (Hales et al., 2017). Although health deterioration during midlife is prevalent for

all adults, women are particularly vulnerable to reductions in physical health and well-being

(Harlow & Derby, 2015). For instance, Karvonen-Gutierrez and Ylitalo (2013) reported that 39%

of midlife women experience moderate to extreme difficulty with mobility.

Investigating the substantial physical health decline during midlife is both necessary and rel-

evant. Alemayehu and Warner (2004) demonstrated that for an average adult in the

United States, health care expenses from 40 to 64 years account for as much as one third of life-

time health care expenditures. This constitutes a sizable financial burden for society at large,

especially considering that per capita health care spending in the United States is higher than in

any other developed country (Kurani & Cox, 2020). In addition to excessive medical costs,

physical health deterioration during midlife significantly contributes to excessive levels of mor-

tality. According to Woolf and Schoomaker (2019), death rates for individuals aged 25 to

64 years increased from 328.5 to 348.2 deaths per 100,000 between 2010 and 2017. This escala-

tion hurts life expectancy and enlarges the gaps in life expectancy between the United States

and its developed peers (Ortaliza et al., 2021).

Given the magnitude and importance of physical health declines among midlife women,

researchers have proposed various possible explanations for this population health trend. These

include increases in deaths of despair (i.e., drug overdoses, alcohol abuse, and suicide), income

inequality, and economic shocks (Case & Deaton, 2015; Woolf & Schoomaker, 2019). In spite

of this developing literature, scholars recognize that much about what produces considerable

physical health deterioration during midlife is still unknown (Lachman, 2004). As midlife is fre-

quently characterized as a life course stage of considerable familial upheaval, a notable gap in

the literature is the influence of simultaneous care work to both aging parents and young chil-

dren (i.e., sandwich caregiving) on midlife women’s physical health. To assess this association

more accurately, this study uses six waves of data from the National Longitudinal Survey of

Youth 1979 to (a) analyze the relationship between sandwich caregiving and mothers’physical

health during midlife and (b) determine the extent to which this association differs by race.

Background

Women during midlife

Midlife is commonly defined as a period between younger and older adulthood when adults are

40 to 65 years old. Many women in this life course stage have entered long-term relationships,

had children, started a career, cared for aging parents, and managed a household. Previous lit-

erature on women’s experience during midlife portrays it as a life course stage in transition,

where women often juggle competing demands at work and at home, in addition to

3292 FAMILY RELATIONS