Social Science & Medicine最新文献_第10页

Corrigendum to ‘“Learning to stay silent”: Coping, help-seeking and mitigation strategies for intimate partner violence against men in Kenya’ [Soc. Sci. Med. Volume 388, January 2026, 118694] “学会保持沉默”：应对、寻求帮助和缓解肯尼亚男性遭受亲密伴侣暴力的策略”的更正[Soc]。科学。医学。卷388,2026年1月，118694]。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.socscimed.2026.119063

Jacinta Mukulu Waila , Olaf Horstick , Domnick Onyango Mitiro , Christine Wayua Musyimi , Michael Lowery Wilson

引用次数: 0

The impact of media coverage of a celebrity suicide on suicide and attempted suicide rates in Taiwan 媒体报导名人自杀对台湾自杀率及企图自杀率的影响。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI: 10.1016/j.socscimed.2026.118994

Ying-Yeh Chen , Vera Yu Men , Cheuk Yui Yeung , Kevin Chien-Chang Wu , Ying-Chen Chi , Paul SF. Yip

Media coverage of celebrity suicides can shape population-level suicidal behavior, yet most existing evidence focuses on mortality rather than non-fatal attempts. This study investigates the impact of media coverage following the suicide of Chiung Yao, an 86-year-old best-selling novelist and cultural figure in Chinese-speaking societies, on suicide mortality and suicide attempts in Taiwan.

We drew on suicide attempt data from Taiwan's National Suicide Surveillance System and mortality data from the Taiwan Death Registry. Using an interrupted time-series design with quasi-Poisson regression, we analyzed seven-day rolling counts of suicide attempts and deaths during the four weeks before and after her death (December 4th, 2024), stratified by sex, age group, and suicide method.

No significant overall changes in suicide attempts or mortality were observed. However, suicide attempts increased by 12.3 % among women aged 45–64 (IRR = 1.123; 95 % CI: 1.030–1.225), with a slight increase of the post-death trend among women aged 25–44. Suicide deaths by charcoal burning, the method used by the celebrity, increased by 47.0 % (IRR = 1.470; 95 % CI: 1.195–1.807), and mortality among men aged 25–44 and ≥65 rose by 35.5 % (IRR = 1.355; 95 % CI: 1.095–1.679) and 20.7 % (IRR = 1.207; 95 % CI: 0.992–1.468), respectively.

Media coverage of the suicide of an older celebrity was not associated with population-level increases in suicide, but associated with method- and subgroup-specific changes in suicide attempts and mortality. These findings highlight the importance of monitoring media practices with attention to differential vulnerability following highly publicized suicides.

媒体对名人自杀的报道可以影响大众层面的自杀行为，然而，大多数现有证据关注的是死亡率，而不是非致命性的自杀企图。摘要本研究探讨台湾86岁畅销小说家、华语社会文化人物琼瑶自杀事件后，媒体报导对台湾自杀死亡率及自杀企图的影响。使用准泊松回归的中断时间序列设计，我们分析了她死亡前后（2024年12月4日）四周内7天的自杀企图和死亡滚动计数，并按性别、年龄组和自杀方式分层。在自杀企图和死亡率方面没有观察到明显的总体变化。然而，45-64岁妇女的自杀企图增加了12.3% (IRR = 1.123; 95% CI: 1.030-1.225)， 25-44岁妇女的死后趋势略有增加。名人使用的燃烧木炭自杀死亡人数增加了47.0% (IRR = 1.470; 95% CI: 1.195-1.807)， 25-44岁和≥65岁男性的死亡率分别增加了35.5% （IRR = 1.355; 95% CI: 1.095-1.679）和20.7% （IRR = 1.207; 95% CI: 0.992-1.468）。媒体对年长名人自杀的报道与人口自杀率的上升无关，但与方法和亚群体特定的自杀企图和死亡率的变化有关。这些发现强调了监测媒体做法的重要性，并注意高度宣传自杀后的不同脆弱性。

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引用次数: 0

Trends in adults body mass index related to changes in socioeconomic status of 201 large Latin American cities 201个拉美大城市成人体重指数变化趋势与社会经济地位变化的关系

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-09 DOI: 10.1016/j.socscimed.2026.118966

Mónica Serena Perner , Kari Moore , Andrés Trotta , Hal Chen , Mariana Lazo , Olga L. Sarmiento , Daniel Rodriguez , Marcio Alazraqui , Ana V. Diez Roux

Background

The prevalence of obesity has increased worldwide. The association between socioeconomic urban development in the nutritional status of the population in large cities from low and middle-income countries is unclear.

Aim

Analyze how time trends in adult BMI vary across large cities and examine whether city socioeconomic status (SES) is related to adult BMI trends and whether individual level SES modifies this relationship.

Methods

We analyzed different cross-sectional health surveys done between 2000 and 2019, in Argentina, Brazil, Chile, Colombia, and Mexico, compiled as part of the SALURBAL study. Hybrid models adjusted for individual age and education were used to estimate associations of city-level education with differences in BMI, and associations of changes in city-level SES with changes in city BMI (change vs. change). Effect modification by individual-level education was assessed. Models were stratified by sex and country.

Results

We included 285,670 individuals from 201 cities. BMI increased over time in all countries except Brazil (women) and Chile (men), where it was not statistically significant. We did not find consistent evidence that average city education consistently modified trends in BMI. However, within city increases in city education were related to decreases in BMI in women (Chile and Colombia) and in men (Brazil, Chile, and Colombia). These effects were stronger in women with lower education.

Conclusion

In low- and middle-income countries changes over time in city SES impact BMI trends in complex ways. A better understanding of the mechanisms involved may help develop better strategies to prevent increases in obesity.

世界范围内，肥胖症的患病率有所上升。社会经济城市发展与中低收入国家大城市人口营养状况之间的关系尚不清楚。目的分析大城市成人BMI的时间变化趋势，研究城市社会经济地位（SES）是否与成人BMI趋势相关，以及个体社会经济地位是否改变了这种关系。方法：我们分析了2000年至2019年间在阿根廷、巴西、智利、哥伦比亚和墨西哥进行的不同横断面健康调查，这些调查是SALURBAL研究的一部分。采用经个人年龄和受教育程度调整的混合模型估计城市受教育程度与BMI差异的关系，以及城市社会经济地位变化与城市BMI变化的关系（change vs. change）。评估个体教育对效果的影响。模型按性别和国家分层。结果我们纳入了来自201个城市的285670人。除了巴西（女性）和智利（男性）以外，所有国家的BMI都随着时间的推移而增加，这两个国家的BMI在统计上并不显著。我们没有发现一致的证据表明城市平均教育水平能持续改变BMI的趋势。然而，在城市内，城市教育水平的提高与女性（智利和哥伦比亚）和男性（巴西、智利和哥伦比亚）的BMI下降有关。这些影响在受教育程度较低的女性中更为明显。结论在低收入和中等收入国家，城市社会经济地位随时间的变化以复杂的方式影响BMI趋势。更好地了解其中的机制可能有助于制定更好的策略来防止肥胖的增加。

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引用次数: 0

Incidence of dementia diagnosis in Denmark, 1986–2023: an age-period-cohort analysis 1986-2023年丹麦痴呆诊断发病率：一项年龄期队列分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.socscimed.2026.118951

Julia Callaway, Cosmo Strozza, Óskar Daði Jóhannsson

Denmark is experiencing unprecedented population ageing, highlighting the importance of understanding age-related diseases, including dementia. Dementia is a syndrome characterised by progressive decline in cognitive function that interferes with daily activities and independent living. This study quantifies changes in dementia diagnosis across ages, time periods, and birth cohorts in Denmark. Using Danish registry data from 1986 to 2023, we analysed all individuals aged 50 and older, corresponding to the birth cohorts 1886–1973. We conducted an age-period-cohort analysis and stratified by sex. Dementia diagnosis was measured by either: 1) hospitalisation for dementia via ICD codes; or 2) filling at least two prescriptions for a dementia-related drug. Dementia diagnoses increased with age across cohorts and periods. The age effect showed rates beginning to rise around age 75 and peaking in the late 80s and early 90s. Looking at the period effect, incidence rates begin to increase in 1997 when the first dementia-related drugs became available, followed by a decrease in later years. Younger cohorts showed lower dementia incidence rates compared to older cohorts at similar ages, likely due to changes to modifiable risk factors. Findings from this study contribute to understanding dementia risks on the age, period, and cohort levels, and can inform public health policies aimed at diagnosing cognitive decline and improving quality of life for older populations.

丹麦正在经历前所未有的人口老龄化，这突出了了解包括痴呆症在内的与年龄有关的疾病的重要性。痴呆症是一种以认知功能进行性下降为特征的综合征，妨碍了日常活动和独立生活。这项研究量化了丹麦不同年龄、时间段和出生队列的痴呆诊断的变化。使用1986年至2023年的丹麦登记数据，我们分析了所有年龄在50岁及以上的个体，对应于1886年至1973年的出生队列。我们进行了年龄期队列分析，并按性别分层。痴呆诊断通过以下两种方式进行测量：1)通过ICD代码进行痴呆住院治疗；或者2)开具至少两张与痴呆症有关的药物处方。痴呆的诊断随着年龄的增长而增加。年龄效应表明，自杀率在75岁左右开始上升，在80年代末和90年代初达到顶峰。从时期效应来看，1997年第一批与痴呆症相关的药物问世后，发病率开始上升，随后几年发病率下降。与年龄相仿的老年队列相比，年轻队列显示出较低的痴呆发病率，可能是由于可改变的风险因素的变化。这项研究的发现有助于了解年龄、时期和队列水平上的痴呆风险，并可以为旨在诊断认知能力下降和改善老年人生活质量的公共卫生政策提供信息。

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引用次数: 0

Policing and care in mental health crisis response: Boundary work and the politics of safety and authority 心理健康危机应对中的警务和护理：边界工作和安全和权威政治

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-17 DOI: 10.1016/j.socscimed.2026.118982

Mark D. Fleming , Dani MacVicar , Aoife M. McDermott , Amanda L. Brewster

Demands for alternatives to police responses to mental health crises have driven significant transformations in the frontlines of emergency care. This ethnographic study (2022-2025) analyzes how the boundaries between policing and behavioral health have been negotiated, contested, and reconstructed during the implementation of a large-scale crisis response initiative in California, USA. Taking an ethnographic approach, we demonstrate how boundary work among law enforcement, behavioral health professionals, and organizational leaders unfolds through intertwined dynamics of competition, collaboration, and reconfiguration. Our findings highlight how boundary work is embedded within broader socio-political contexts shaped by advocacy for racial justice, critiques of police violence, and demands for systemic reform. Specifically, we reveal how the frontline enactment of crisis response is characterized by ongoing negotiations around authority, legitimacy, safety, and care, reflecting and reshaping political and ethical debates on criminalization and police reform. This paper contributes to boundary work theory by illustrating how professional and institutional boundaries are dynamic sites of dialectical engagement that both respond to and actively shape contemporary struggles around race, violence, mental health, and justice.

对警察应对心理健康危机的替代方案的需求，推动了急救一线的重大变革。这项民族志研究（2022-2025）分析了在美国加利福尼亚州实施大规模危机应对计划期间，警务和行为健康之间的界限是如何协商、争议和重建的。采用人种学方法，我们展示了执法部门、行为健康专业人员和组织领导者之间的边界如何通过竞争、合作和重组的相互交织的动态展开。我们的研究结果强调了边界工作如何嵌入更广泛的社会政治背景中，这些背景是由倡导种族正义、批评警察暴力和要求系统改革所形成的。具体来说，我们揭示了危机应对的前线制定是如何以围绕权威、合法性、安全和关怀的持续谈判为特征的，反映和重塑了关于刑事定罪和警察改革的政治和伦理辩论。本文通过说明专业和机构边界如何成为辩证参与的动态场所，既回应又积极塑造当代围绕种族、暴力、心理健康和正义的斗争，为边界工作理论做出了贡献。

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引用次数: 0

Participation in the house-ball community as a social determinant of HIV care and prevention outcomes among transgender women of color 参与家庭舞会社区是有色人种变性妇女艾滋病护理和预防结果的社会决定因素。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-25 DOI: 10.1016/j.socscimed.2026.119035

Alexander Furuya , Cho-Hee Shrader , Makella Coudray , Ichiro Kawachi , Asa Radix , Jenesis Merriman , Denton Callander , Dustin T. Duncan

House-ball scenes around the world have historically been a community for queer people to form chosen families and social networks and be exposed to community health campaigns. We investigated the impact of house-ball participation on HIV care and prevention outcomes among transgender women of color (TWOC) living in New York City. We asked 178 participants who identified as TWOC about their participation in the house-ball scene (never, former, current), and we asked them about their status-neutral HIV care and prevention outcomes, including HIV/STI testing, condom use, PrEP use, and HIV viral load suppression. We used Targeted Maximum Likelihood Estimation (TMLE) to estimate the adjusted relative risk of house-ball participation on these baseline outcomes; we included age, education, and US-born nativity as potential confounders. Among TWOC living with HIV (n = 94; 52.8 %), we found a positive effect of current participation in the house-ball scene on past six-month STI testing compared to never participation (Relative Risk: 1.20, 95 % CI: [1.07, 1.34]). Among TWOC not living with HIV (n = 84; 45.2 %), we found a positive effect of current participation in the house-ball scene on past six-month HIV testing (Relative Risk: 1.27, 95 % CI: [1.11, 1.44]). We found that those who formerly participated in the house-ball scene were less likely to currently use PrEP compared to those who never participated (Relative Risk: 0.44, 95 % CI: [0.23, 0.88]). Community, network connections, and exposure to health campaigns within the house-ball scene may enable and motivate individuals to achieve better HIV care and prevention outcomes.

历史上，世界各地的家庭舞会一直是酷儿群体组成特定家庭和社交网络的社区，并参与社区健康运动。我们调查了居住在纽约市的有色人种变性女性（TWOC）参加家庭舞会对艾滋病护理和预防结果的影响。我们询问了178名被确定为TWOC的参与者关于他们参加家庭舞会的情况（从未，以前，现在），我们询问了他们的中立状态HIV护理和预防结果，包括HIV/STI检测，避孕套使用，PrEP使用和HIV病毒载量抑制。我们使用目标最大似然估计（TMLE）来估计参加家庭舞会对这些基线结果的调整后相对风险；我们将年龄、教育程度和出生在美国作为潜在的混杂因素。在感染艾滋病毒的TWOC中（n = 94;52.8 %），我们发现与从未参与相比，目前参加家庭舞会对过去六个月性传播感染检测有积极影响（相对风险：1.20,95 % CI:[1.07, 1.34]）。在未感染艾滋病毒的TWOC中（n = 84;45.2% %），我们发现目前参加家庭舞会对过去六个月的艾滋病毒检测有积极影响（相对风险：1.27,95 % CI:[1.11, 1.44]）。我们发现，与从未参加过家庭舞会的人相比，以前参加过家庭舞会的人目前使用PrEP的可能性更小（相对风险：0.44,95 % CI:[0.23, 0.88]）。社区、网络连接和接触家庭舞会现场的健康运动可能使并激励个人实现更好的艾滋病毒护理和预防结果。

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引用次数: 0

The privilege to heal? Mapping patients’ unequal mobilisation of health capital in a Nordic welfare context 治愈的特权？在北欧福利背景下绘制患者对卫生资本的不平等调动

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.socscimed.2026.118962

Kristian Larsen , Ina Koch Røpke , Mette Rørth , Anette Lykke Hindhede

In the Nordic egalitarian countries, relative equality is expected in relation to individual health in-vestments and outcomes. This study explores a heterogeneous sample of patients’ bodily investment strategies when illness occurs. A questionnaire was conducted with 503 patients from the Capital Region of Denmark. Using Multiple Correspondence Analysis (MCA), the study identifies unequal and distinct patterns of bodily health capital investment. Two dimensions emerged: disruption vs. continuity and liberal vs. conservative. These dimensions revealed opposing patient groups. Active engagement in bodily investment strategies was associated with younger, female, highly educated patients with chronic or disruptive conditions such as heart transplants or psychiatric illnesses. Con-versely, lower engagement was observed among older, less educated patients with lower incomes, particularly those treated in departments of comorbidity, geriatrics, or orthopaedics. The analysis further demonstrates that a high volume of health capital is closely tied to social class through the conversion of capitals: we see emerging distinctions of economic and cultural resources which provide patients the dispositions needed, to recognise and mobilise body investment. Thus, the study shows that classed, gendered, and age-based inequalities in healing persist even within a universal welfare system, revealing the enduring social structuring of health capital.

在奉行平等主义的北欧国家，预计在个人卫生投资和成果方面将实现相对平等。本研究探讨了患者在疾病发生时的身体投资策略的异质样本。对来自丹麦首都地区的503名患者进行问卷调查。利用多重对应分析（MCA），该研究确定了身体健康资本投资的不平等和不同模式。两个维度出现了：颠覆vs.延续，自由vs.保守。这些维度揭示了相反的患者群体。积极参与身体投资策略与患有慢性或破坏性疾病（如心脏移植或精神疾病）的年轻、受过高等教育的女性患者有关。相反，在年龄较大、受教育程度较低、收入较低的患者中，尤其是在合并症、老年病学或骨科治疗的患者中，参与度较低。分析进一步表明，通过资本的转换，大量的医疗资本与社会阶层密切相关：我们看到经济和文化资源的新兴差异，这些差异为患者提供了识别和调动身体投资所需的处置。因此，该研究表明，即使在一个普遍的福利体系中，基于阶级、性别和年龄的治疗不平等仍然存在，这揭示了健康资本的持久社会结构。

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引用次数: 0

‘It's very hard, it's very very difficult ….’ Exploring the lived experiences of managing diabetes among young people living with type 1 diabetes in underserved communities in Ghana 这非常困难，非常非常困难....“探索加纳服务不足社区中患有1型糖尿病的年轻人管理糖尿病的生活经验

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.socscimed.2025.118919

Joseph Kangmennaang , Alhassan Siiba , Prince Ofori-Boateng , Nana Ama Barnes Amoa , Yacoba Atiase , Elizabeth Bankah

Sub-Saharan Africa (SSA) is undergoing an epidemiological transition which is driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). In Ghana, while the prevalence of diabetes is generally increasing, type 1 diabetes mellitus (T1DM) is increasing at a higher rate (9.5 %) among young people compared to type 2 diabetes (4.9 %) mellitus (T2DM). T1DM differs from T2DM in that it is not readily preventable, children are often diagnosed late, or diagnoses are missed entirely, and living with T1DM requires a different approach to care. Young people living with diabetes (PLWDs) and their caregivers often have new responsibilities placed on them. Given the increasing burden of diabetes among young people, and the lack of targeted prevention strategies coupled with inadequate care for young PLWDs in Ghana, there is an urgent need to identify context-relevant challenges to guide the development of interventions aimed at improving diabetes management outcomes. As part of a larger research program exploring diabetes risks and management in underserved communities, this paper explores the barriers and facilitators of managing diabetes among young people. We conducted photovoice interviews with young PLWDs (n = 21) in Kumasi and Wa, Ghana. The key themes that emerged include sociocultural barriers and norms, the food environment, and embodied experiences including pains and scars from insulin injections. Overall, notwithstanding the insights generated from this study, further quantitative research may be useful to support the design of targeted preventive and management strategies for young people living with T1DM in Ghana and in other LMICs.

撒哈拉以南非洲（SSA）正在经历流行病转型，导致糖尿病和其他非传染性疾病的风险和流行率上升。在加纳，虽然糖尿病的患病率普遍上升，但与2型糖尿病（4.9%）相比，年轻人中1型糖尿病（T1DM）的增长率（9.5%）更高。1型糖尿病与2型糖尿病的不同之处在于，它不易预防，儿童往往诊断较晚，或诊断完全遗漏，并且1型糖尿病患者需要不同的护理方法。患有糖尿病的年轻人及其照顾者往往肩负着新的责任。鉴于加纳年轻人的糖尿病负担日益加重，缺乏有针对性的预防策略，加上对年轻糖尿病患者的护理不足，迫切需要确定与环境相关的挑战，以指导旨在改善糖尿病管理结果的干预措施的发展。作为一个更大的研究项目的一部分，探索在服务不足的社区糖尿病的风险和管理，本文探讨了在年轻人中管理糖尿病的障碍和促进因素。我们对加纳库马西和瓦的年轻plwd （n = 21）进行了照片语音采访。出现的关键主题包括社会文化障碍和规范，食物环境，以及胰岛素注射带来的疼痛和疤痕等具体体验。总的来说，尽管这项研究产生了一些见解，但进一步的定量研究可能有助于为加纳和其他中低收入国家患有T1DM的年轻人设计有针对性的预防和管理策略。

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引用次数: 0

“I'm not moving from here until you resolve this for me”: mothers of disabled children overcoming barriers to health care “你不帮我解决这个问题，我就不离开这里”：残疾儿童的母亲克服获得医疗保健的障碍

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-10 DOI: 10.1016/j.socscimed.2026.118954

Rosamund Greiner

Mothers of disabled children typically fulfil the role of the primary caregiver. For mothers of children with Congenital Zika Syndrome in Colombia, the caregiver role extends far beyond the provision of direct personal care within the private sphere of the home. Their children require specialist interventions, and mothers negotiate access on behalf of their children. In the process, they frequently encounter barriers to timely access to healthcare and welfare for their child. Barriers and facilitators have received significant attention in the literature, but caregivers responses to barriers have been largely overlooked. Drawing on ethnographic research conducted between February 2022 and March 2023 with mothers of children with Congenital Zika Syndrome in Barranquilla, Colombia, I address this gap. In my analysis, I bring together Menéndez’ concept of autoatención (self-management) with Madden's conceptualisation of cultural health capital to explore how mothers respond to barriers and negotiate access to healthcare on behalf of their child. They adopt diverse strategies to draw together formal and informal spaces of attention and care, make use of both biomedical and alternative interventions, and share information about how they manage their child's health with other caregivers. This analysis highlights the essential role of their gendered reproductive labour in ensuring healthcare access and efficacy.

残疾儿童的母亲通常扮演主要照顾者的角色。在哥伦比亚，对于患有先天性寨卡综合征儿童的母亲来说，照顾者的作用远远超出了在家庭私人领域提供直接的个人护理。他们的孩子需要专门的干预，母亲们代表他们的孩子进行谈判。在这一过程中，她们经常遇到障碍，无法及时为子女获得保健和福利。障碍和促进者在文献中受到了极大的关注，但照顾者对障碍的反应在很大程度上被忽视了。根据2022年2月至2023年3月期间在哥伦比亚巴兰基亚对患有先天性寨卡综合征儿童的母亲进行的人种学研究，我解决了这一差距。在我的分析中，我将mensamendez的autoatención（自我管理）概念与Madden的文化健康资本概念结合起来，探讨母亲如何应对障碍，并代表孩子协商获得医疗保健的机会。她们采取多种战略，将正式和非正式的关注和照顾空间结合起来，利用生物医学和替代干预措施，并与其他照顾者分享关于如何管理子女健康的信息。这一分析强调了她们按性别划分的生殖劳动在确保获得保健服务和保健效果方面的重要作用。

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引用次数: 0

Why do inpatients bypass secondary hospitals? A discrete choice analysis of reputation, specialty matching, and travel time in China's hierarchical healthcare system 住院病人为什么不去二级医院？中国分级医疗体系中声誉、专业匹配和出行时间的离散选择分析。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.socscimed.2026.119051

Jiarui Han , Liping Fu , Wenhao Hu , Yingyi Zhang , Kunmeng Li

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.

尽管有针对性的政策干预，中国分级医疗体系中的患者仍然坚持选择三级医院而不是二级医院进行住院治疗。利用参与中国和平百万人项目的中国主要城市住院数据的离散选择模型，我们基于2016年至2023年收集的记录，最终样本为1894例，检查了住院患者的住院选择权衡。我们的分析明确区分了机构声誉与特定疾病的专业知识，并调查了这些权衡在急诊和非急诊入院之间的差异。结果表明，患者明确优先考虑专科匹配而不是机构声誉，特别是在急诊入院和严重心脑血管疾病患者中。出行意愿（WTT）计算表明，患者愿意接受平均14.8分钟的额外出行时间，以获得更好的专业定位。此外，我们的分析确定了显著的偏好异质性，揭示了个体社会经济特征和医院属性之间相互作用产生的系统性差异。分解分析阐明了二级医院的关键结构劣势，主要源于专业对齐不足和住院时间过长。这些发现强调了解决供给侧约束和需求侧分类的改革必要性，方法是加强二级医院在特定疾病方面的作用，将其整合到医疗联盟中，并将报销规则与临床适当性和转诊途径联系起来。

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