Who cares? Exploring the socio-economic dynamics of informal caregiving trajectories in England

Informal care is a core component of England's long-term care system, yet demographic shifts and austerity threaten its sustainability. This study examines socio-demographic and structural factors shaping informal care trajectories, leveraging newly linked data from the ONS Longitudinal Study 2001-2021 and local-level datasets on adult social care expenditure, care home availability, and area-level deprivation. Guided by the Informal Care Model, we use logistic regression and Fairlie decomposition to analyse transitions into caregiving (n = 550,644) and repeated care (n = 85,500), focusing on care intensity, gender-specific patterns and temporal changes. Results showed that caregiving trajectories were primarily shaped by individual-level factors and barriers to care. Predictors of entering caregiving differed from those associated with intensive and sustained caregiving. Poorer health, lower educational attainment and non-homeownership showed limited associations with caregiving entry overall but were more strongly associated with intensive caregiving among those who became carers. Repeated caregiving was associated with poorer health and non-homeownership, while employment constrained both caregiving intensity and repeated caregiving. Gendered patterns diverged by 2011-2021; employment and poor health increasingly constrained women's transitions into caregiving, whereas poor health remained a positive predictor for men. While women initiated high-intensity care, men were more likely to report it at consecutive censuses. Decomposition analysis showed that changes in health and formal care infrastructure contributed most to the explained component of observed transitions, though much of the overall decline remained unexplained by observed characteristics. The findings highlight a growing inequality, as systemic constraints and demographic pressures concentrate intensive caregiving among the most vulnerable populations.