Social Science & Medicine最新文献

We provide the first detailed cohort analysis of the gender care gap that examines the association between caregiving provision, individual-level poverty, meso-level deprivation, and individual circumstances. Using data from the UK Household Longitudinal Study, we use (i) multilevel mixed-effects logistic regression to provide a detailed age cohort analysis of the probability of providing informal care by sex; and (ii) Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to provide an intersectional examination of informal carers. Our results reveal a clear age pattern in caregiving, peaking between ages 60-70 before declining, with earlier-born cohorts showing higher caregiving likelihood at the same ages than later-born cohorts. The gender care gap is most pronounced among middle-born cohorts (1969-1978, 1959-1968, and 1949-1958), particularly between ages 50 and 60. While overall caregiving prevalence is higher among individuals experiencing poverty and living in deprived areas, the gender care gap is larger among individuals above the poverty line and in non-deprived areas. Caregiving is primarily associated with the independent effects of cohort, gender, poverty, and meso-level deprivation, with limited evidence of multiplicative intersectional effects. Policy attempts to address the gender care gap need to be mindful of these variations, not least because they potentially elucidate the potential sources of gender inequalities in care.

Deep tubewells that procure groundwater from deep arsenic-free aquifers are crucial sources of safe drinking-water in rural Bangladesh. However, their health benefits may be heterogeneous and context dependent: inequitable distribution, long collection distances and continued use of unsafe alternatives may increase microbial contamination and diarrheal disease. We examined whether the association between household deep tubewell use and under-five diarrhea varies across space and how neighborhood context helps explain this variation. Prospective diarrhea surveillance was conducted across 19,203 households with under-five children in Matlab, Bangladesh from March 2018 to October 2019. We fitted hierarchical logistic regression models accounting for spatially varying relationships and neighborhood-level measures of deep tubewell use. In non-spatial models, household deep tubewell use is associated with lower childhood diarrhea (Odds Ratio (OR) 0.81, 95% Uncertainty Interval (UI) 0.68-0.96). Accounting for space suggests spatial confounding and that the effect of household deep tubewell use on diarrhea may change based on location. Additionally, there is evidence of neighborhood effects: households in areas where more than 60% of neighbors used deep tubewells had lower odds of childhood diarrhea than those in neighborhoods with lower deep tubewell use (OR 0.72, 95% UI 0.57-0.92), with strongest protection among households that used deep tubewells. Results suggest that despite positive effects, benefits of deep tubewells are unequally distributed, and increasing deep tubewell density can further reduce childhood diarrheal disease burden in rural Bangladesh. This study highlights the importance of incorporating geographic context in the design and evaluation of drinking-water and other population health interventions.

Objectives: This systematic review and meta-analysis is aimed to critically evaluate and quantify the association between shift work and chronic kidney disease (CKD).

Methods: We searched PubMed, Embase, and Web of Science through May 2025 for observational studies examining shift work-including night or rotating shifts-and CKD outcomes among adults. Eligible outcomes included reduced estimated glomerular filtration rate (eGFR), proteinuria, or albuminuria. Study quality was assessed using the Newcastle-Ottawa Scale, and meta-analyses were performed where feasible.

Results: Twelve studies were included in this systematic review. Most studies defined CKD as eGFR below 60 mL/min/1.73 m² or presence of albuminuria, although outcome definitions varied. Meta-analysis of 6 studies found that shift workers had significantly higher odds of CKD (pooled odds ratio: 1.43; 95% CI: 1.06-1.92) compared to non-shift workers. Risk of bias was moderate to low across studies. Heterogeneity was modest, and no significant publication bias was detected.

Conclusions: Shift work is associated with a modestly increased risk of CKD. Circadian disruption and related metabolic disturbances may underlie this relationship. Given the widespread prevalence of shift work and the global burden of CKD, these findings support the need for targeted occupational health surveillance and preventive strategies for shift-working populations.

The increasing presence of older immigrants in European societies has led to growing interest in how they and their families experience and manage care in ageing. This study aimed to explore the pattern of reflections and expectations of 2^nd generation Turkish immigrants in Norway regarding family care. Qualitative design was employed in this study. The sample consisted of 18 2^ndgeneration individuals of Turkish origin living in Norway. All participants lived in and around the same city in the middle part of Norway. Data was collected through individual face-to-face interviews conducted between November 2024 and January 2025. The transcripts were examined using reflexive thematic analysis. Four main themes were identified. 1) Cultural Background and Caregiving: Traditional Turkish Norms, 2) Intergenerational Care Expectations: Shifting Norms and Values, 3) Family Care Under the Same Roof: Wishes and Realities, and 4) Negotiating Family Care Responsibility. These findings demonstrate that cultural norms and caregiving, intergenerational care expectations, and family care practices are dynamically negotiated among 2^nd generation Turkish immigrants. The findings indicate that while caregiving responsibilities are primarily framed in terms of love and moral obligation, economic, spatial, and emotional challenges significantly complicate this process.

Despite targeted policy interventions, patients within China's hierarchical healthcare system persistently opt for tertiary hospitals over secondary hospitals for inpatient care. Utilizing discrete choice modeling of hospitalization data from a major Chinese city participating in the China PEACE Million Persons Project, we examine inpatient hospital choice trade-offs based on records collected between 2016 and 2023 with a final sample of 1,894 cases. Our analysis explicitly distinguishes institutional prestige from disease-specific expertise and investigates how these trade-offs differ between emergency and non-emergency admissions. Results demonstrate that patients unequivocally prioritize specialty matching over institutional reputation, especially during emergency admissions and among patients with severe cardio-cerebrovascular conditions. Willingness-to-travel (WTT) calculations indicate patients are willing to accept, on average, 14.8 extra minutes of travel time for superior specialty alignment. Furthermore, our analysis identifies significant preference heterogeneity, revealing systematic disparities emerging from interactions between individual socioeconomic characteristics and hospital attributes. Decomposition analysis elucidates critical structural disadvantages of secondary hospitals, primarily stemming from inadequate specialty alignment and prolonged inpatient stays. These findings underscore the need for reforms that address both supply-side constraints and demand-side sorting, by strengthening secondary hospitals' disease-specific roles, integrating them into medical alliances, and linking reimbursement rules to clinical appropriateness and referral pathways.

Gambling is associated with both enjoyment and harm, yet conventional prevalence measures may understate its wider consequences. Subjective wellbeing data offer a broader lens for understanding how gambling relates to individual welfare. Using nationally representative data from the Health Survey for England, we analyse wellbeing across the gambling risk spectrum. Individuals classified as problem gamblers report markedly lower wellbeing than non-gamblers, with a deficit around twice as large as the gap associated with unemployment, conditional on other life circumstances. Wellbeing is also lower among those at lower risk levels, particularly among women, indicating that gambling-related harm extends beyond the small minority formally identified as problem gamblers, consistent with public health frameworks that treat harm as a continuum. By contrast, gambling without problematic indicators is associated with modestly higher wellbeing than abstinence, reflecting the heterogeneity of experiences. These associations are consistent over time and across multiple wellbeing domains, with the exception of optimism. Taken together, the findings highlight the importance of considering a broader group when assessing gambling-related harm, while also calling for proportionate policy responses that address harms without overlooking that many gamblers experience no deficit.

Background: In the evaluation of complex interventions, economic evaluations aim to determine the relative cost-effectiveness of interventions but generate little explanation of how or why contexts and underlying causal mechanisms impact this. Conversely, realist approaches aim to explain 'what works, for whom, in which circumstances and why' but rarely capture the economic costs and consequences of interventions. As a result, many evaluations remain partial.

Objective: To identify past attempts to integrate realist and economic evaluation approaches and summarise the recent developments in realist and economic evaluation approaches in the evaluation of complex health and social care interventions.

Methods: We conducted a series of scoping reviews using online academic databases, personal libraries and expert stakeholder workshops, to identify the theoretical, methodological, and practical challenges and developments in bringing together realist and economic evaluation approaches.

Findings and recommendations: Although increasing, there remain relatively few examples of evaluations that have attempted to integrate realist and economic evaluation approaches, and challenges for their integration mean that further guidance is required. The wider literature indicated challenges in the theoretical (e.g. ontology, causality), methodological (e.g. accounting for context, study design, mixing methods) and practical (e.g. terminology, scale and scope) domains, for which we have developed recommendations.

Conclusion: To deliver services that are both effective and efficient, evaluations must synthesise relevant explanatory evidence with cost and outcome data to enable policymakers and commissioners to make informed decisions. Findings and recommendations from this review were used to inform the development of guidance for the integration of realist and economic evaluation approaches.

Losing a marital partner to death is a stressful life event with adverse health effects, including excess mortality risk. Previous research has focused on examining the widowhood effect within mixed-sex unions. Despite the increasing number of same-sex unions, gender composition within a union has not been considered when investigating the widowhood effect. Utilizing Danish Register Data from 1989 to 2022, this study investigates disparities in mortality risk following partner loss among surviving same-sex and mixed-sex partners. Within three years after widowhood, surviving same-sex partners may have a higher risk of dying than mixed-sex partners, although its statistical significance depends on comparison group. After three years, the mortality disadvantage for surviving same-sex over mixed-sex partners ends or reverses. The results suggest that, in the short term, the health implications of widowhood may be more profound for individuals who were in a same-sex union. Additional minority stress experienced during widowhood, a lack of social support, and higher health concordance among same-sex partners may contribute to increased vulnerability and, consequently, elevated mortality risk. Relationship dynamics within same-sex unions may also prepare surviving same-sex partners to eventually adapt to the new life situation the loss entails.

Subhealth () refers to a liminal state between health and disease that, while lacking clear biomedical markers, has become a prominent target of intervention in China's healthcare landscape. This study examines the socio-political construction of subhealth by integrating bibliometric analysis with historical and political-economic perspectives. Drawing on a dataset of nearly 20,000 Chinese-language publications (1995-2022), complemented by discourse analysis of policy documents and academic literature, we analyze three interrelated dimensions: (1) the commercial and economic dynamics that enabled the proliferation of subhealth-related industries and wellness markets; (2) the scientization of Traditional Chinese Medicine (TCM), which legitimized subhealth through diagnostic standardization and biomedical frameworks; and (3) the institutional support by the Chinese state, which incorporated subhealth into public health campaigns and national development goals. By examining these dimensions together, we argue that subhealth has emerged as a hybrid construct shaped by the convergence of market incentives, scientific discourse, and state strategies. This case offers new insight into how medical categories are socially engineered and mobilized within a unique configuration of post-socialist governance and health reform.