Sex and gender differences in caregiver burden among family caregivers of persons with dementia: A systematic review and meta-analysis

Abstract

OBJECTIVE: This systematic review and meta-analysis examined sex and gender differences in caregiver burden among family caregivers of persons with dementia and explored variations by region and country income level. METHODS: Following PRISMA guidelines, a comprehensive literature search was conducted in four databases (CINAHL, PubMed, EMBASE, and PsycINFO), including studies up to December 2024. Forty-seven studies representing 24 countries were included in the systematic review, with 39 studies (41 effect sizes) included in the meta-analysis. A random-effects model was used to calculate pooled effect sizes (Cohen's d), and subgroup analyses were performed based on region and national income level. RESULTS: Across the 47 studies, 14,919 family caregivers participated, of whom 70 % were women. Most family caregivers were either spouses (44 %) or adult children (43 %). Care recipients were predominantly diagnosed with Alzheimer's disease. Female caregivers reported significantly greater burden than males (Cohen's d= 0.21, 95 % CI: 0.13-0.29, p< 0.001). Subgroup analyses showed higher burden in Asian countries (d= 0.27) compared to Western countries (d= 0.19), though the difference was not statistically significant. High-income countries showed greater disparities (d= 0.21) than middle-income countries (d= 0.16), with no significant difference. High heterogeneity was observed among Western and high-income countries. CONCLUSION: Female family caregivers experience a higher burden than male caregivers across regions and economic settings. Although regional and income-level subgroup differences were not statistically significant, findings underscore the role of cultural and structural contexts in shaping caregiver burden. Gender-sensitive, context specific interventions are essential to address these disparities.

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