Pub Date : 2026-02-02DOI: 10.1016/j.socscimed.2026.119055
Jiyoun Jung , Cheol Whee Park , Dong-Wook Lee , Seong-Sik Cho , Seilin Uhm , Jongin Lee , Mo-Yeol Kang
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.
目的：本系统综述和荟萃分析旨在批判性地评估和量化轮班工作与慢性肾脏疾病（CKD）之间的关系。方法：我们检索了PubMed， Embase和Web of Science到2025年5月的观察性研究，研究轮班工作（包括夜班或轮班）和成人CKD结局。符合条件的结果包括肾小球滤过率（eGFR）、蛋白尿或蛋白尿降低。使用纽卡斯尔-渥太华量表评估研究质量，并在可行的情况下进行荟萃分析。结果：本系统综述纳入了12项研究。大多数研究将CKD定义为eGFR低于60 mL/min/1.73 m2或存在蛋白尿，尽管结果定义各不相同。6项研究的荟萃分析发现，与非轮班工人相比，轮班工人患慢性肾病的几率明显更高（合并优势比：1.43;95% CI: 1.06-1.92）。所有研究的偏倚风险为中到低。异质性不大，未发现显著的发表偏倚。结论：轮班工作与CKD风险适度增加有关。昼夜节律紊乱和相关的代谢紊乱可能是这种关系的基础。鉴于轮班工作的普遍存在和CKD的全球负担，这些发现支持了对轮班工作人群进行有针对性的职业健康监测和预防策略的必要性。
{"title":"Shift work and risk of chronic kidney disease: A systematic review and meta-analysis","authors":"Jiyoun Jung , Cheol Whee Park , Dong-Wook Lee , Seong-Sik Cho , Seilin Uhm , Jongin Lee , Mo-Yeol Kang","doi":"10.1016/j.socscimed.2026.119055","DOIUrl":"10.1016/j.socscimed.2026.119055","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review and meta-analysis is aimed to critically evaluate and quantify the association between shift work and chronic kidney disease (CKD).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Twelve studies were included in this systematic review. Most studies defined CKD as eGFR below 60 mL/min/1.73 m<sup>2</sup> 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119055"},"PeriodicalIF":5.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inequities in systolic blood pressure (SBP), a widely used biomarker, have been shown to be patterned by age, sex, and socioeconomic position, but few studies have investigated how they combine to result in differential SBP risk. This study brings new insights by simultaneously considering sex, age, education, as well as race/ethnicity - a dimension seldom investigated in French health studies- in an intersectional perspective.
Using data from the CONSTANCES cohort (2012–2021) in the French general population, we applied intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine SBP levels among 150,739 adults, not under BP lowering treatment, nested within 126 intersectional strata.
Our models revealed substantial heterogeneity in SBP across strata, mainly driven by age and sex additive main effects. Older age, male sex, lower education, and Subsaharan African (SSA) and Overseas France (DROMs) groups were associated with increased SBP. SSA and DROMs individuals with fewer years of formal education consistently exhibited among the highest SBP values within each sex-age combination. Although age explained most of the between-strata variance, 25-39-year-old SSA and DROMs with fewer years of formal education displayed higher SBP levels than some 40–59-year-old individuals from other ethnoracial backgrounds, suggesting a premature increase of SBP levels for these strata.
Our results show that SBP varies according to socially structured experiences, to the disadvantage of marginalized social groups. They emphasize the need for more intersectionality-grounded research on a wider range of biomarkers, and advocate for a more systematic inclusion of racism as a major axis of oppression in health inequities studies.
{"title":"An intersectional approach to understanding systolic blood pressure distribution in a large French study: a MAIHDA analysis","authors":"Léna Silberzan , Fé·e Santos , Ainhoa Ugarteche-Perez , Emmanuel Wiernik , Nathalie Bajos , Michelle Kelly-Irving","doi":"10.1016/j.socscimed.2026.119054","DOIUrl":"10.1016/j.socscimed.2026.119054","url":null,"abstract":"<div><div>Inequities in systolic blood pressure (SBP), a widely used biomarker, have been shown to be patterned by age, sex, and socioeconomic position, but few studies have investigated how they combine to result in differential SBP risk. This study brings new insights by simultaneously considering sex, age, education, as well as race/ethnicity - a dimension seldom investigated in French health studies- in an intersectional perspective.</div><div>Using data from the CONSTANCES cohort (2012–2021) in the French general population, we applied intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine SBP levels among 150,739 adults, not under BP lowering treatment, nested within 126 intersectional strata.</div><div>Our models revealed substantial heterogeneity in SBP across strata, mainly driven by age and sex additive main effects. Older age, male sex, lower education, and Subsaharan African (SSA) and Overseas France (DROMs) groups were associated with increased SBP. SSA and DROMs individuals with fewer years of formal education consistently exhibited among the highest SBP values within each sex-age combination. Although age explained most of the between-strata variance, 25-39-year-old SSA and DROMs with fewer years of formal education displayed higher SBP levels than some 40–59-year-old individuals from other ethnoracial backgrounds, suggesting a premature increase of SBP levels for these strata.</div><div>Our results show that SBP varies according to socially structured experiences, to the disadvantage of marginalized social groups. They emphasize the need for more intersectionality-grounded research on a wider range of biomarkers, and advocate for a more systematic inclusion of racism as a major axis of oppression in health inequities studies.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119054"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 2nd generation Turkish immigrants in Norway regarding family care. Qualitative design was employed in this study. The sample consisted of 18 2ndgeneration 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 2nd 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.
{"title":"Family care reflections and expectations among 2nd generation Turkish immigrants in Norway: A qualitative study","authors":"Büşra Nur Temür , Nilgün Aksoy , Lillian Karlsen , Anne-Sofie Helvik","doi":"10.1016/j.socscimed.2026.119046","DOIUrl":"10.1016/j.socscimed.2026.119046","url":null,"abstract":"<div><div>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<sup>nd</sup> generation Turkish immigrants in Norway regarding family care. Qualitative design was employed in this study. The sample consisted of 18 2<sup>nd</sup>generation 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) <em>Cultural Background and Caregiving: Traditional Turkish Norms,</em> 2) <em>Intergenerational Care Expectations: Shifting Norms and Values,</em> 3) <em>Family Care Under the Same Roof: Wishes and Realities, and</em> 4) <em>Negotiating Family Care Responsibility.</em> These findings demonstrate that cultural norms and caregiving, intergenerational care expectations, and family care practices are dynamically negotiated among 2<sup>nd</sup> 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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119046"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 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.
{"title":"Why do inpatients bypass secondary hospitals? A discrete choice analysis of reputation, specialty matching, and travel time in China's hierarchical healthcare system","authors":"Jiarui Han , Liping Fu , Wenhao Hu , Yingyi Zhang , Kunmeng Li","doi":"10.1016/j.socscimed.2026.119051","DOIUrl":"10.1016/j.socscimed.2026.119051","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119051"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.socscimed.2026.119001
Kate LaForge
Young adults continue to suffer from high rates of suicidal ideation (SI), attempts, and deaths. How young adults enact help-seeking in their daily lives remains undertheorized. To fill this gap, this study draws from assemblage theory to explore how young adults seek help for SI. Utilizing one-on-one interviews with 39 young American adults conducted from January to July 2024, I draw from assemblage theory to offer a relational understanding of how, in the context of suicide-related help-seeking, diverse elements gather together to construct care. In the first two sections, I examine two phenomena—intimacy and spatiality—that function contingently, flowing through variably scaled assemblages, motivating courses of action, and producing particular affective experiences and relations. In the final section, I explore how these relations prime participants for a practice I call attuned disclosure, in which, given temporary arrangements of particular assemblage elements such as risk logics and technological affordances, young adults calibrate SI disclosure to achieve their desired level of care. This perspective facilitates understanding suicide-related help-seeking not as a set of behaviors but rather as a terrain on which relations between diverse entities, including services, affects, logics, and individuals, are forged and disbanded. In this perspective, help is not sought, but rather, enacted. This focus suggests that, to enhance services for young adults with SI, service providers and broader service systems may benefit from considering help-seeking practices as temporary, emergent, and highly contextual, flowing from subtle impressions and affects, and susceptible to rapid rearrangements.
{"title":"Enacting assemblages of care: How young adults seek support for suicidal ideation","authors":"Kate LaForge","doi":"10.1016/j.socscimed.2026.119001","DOIUrl":"10.1016/j.socscimed.2026.119001","url":null,"abstract":"<div><div>Young adults continue to suffer from high rates of suicidal ideation (SI), attempts, and deaths. How young adults enact help-seeking in their daily lives remains undertheorized. To fill this gap, this study draws from assemblage theory to explore how young adults seek help for SI. Utilizing one-on-one interviews with 39 young American adults conducted from January to July 2024, I draw from assemblage theory to offer a relational understanding of how, in the context of suicide-related help-seeking, diverse elements gather together to construct care. In the first two sections, I examine two phenomena—intimacy and spatiality—that function contingently, flowing through variably scaled assemblages, motivating courses of action, and producing particular affective experiences and relations. In the final section, I explore how these relations prime participants for a practice I call <em>attuned disclosure,</em> in which, given temporary arrangements of particular assemblage elements such as risk logics and technological affordances, young adults calibrate SI disclosure to achieve their desired level of care. This perspective facilitates understanding suicide-related help-seeking not as a set of behaviors but rather as a terrain on which relations between diverse entities, including services, affects, logics, and individuals, are forged and disbanded. In this perspective, help is not sought, but rather, enacted. This focus suggests that, to enhance services for young adults with SI, service providers and broader service systems may benefit from considering help-seeking practices as temporary, emergent, and highly contextual, flowing from subtle impressions and affects, and susceptible to rapid rearrangements.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119001"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.socscimed.2026.119060
David Forrest, Ian McHale, Kaori Narita, Ayan Orujov
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.
{"title":"Gambling and wellbeing: Uneven gains and deficits across risk levels","authors":"David Forrest, Ian McHale, Kaori Narita, Ayan Orujov","doi":"10.1016/j.socscimed.2026.119060","DOIUrl":"10.1016/j.socscimed.2026.119060","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119060"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.socscimed.2026.119050
Andrew Fletcher , Sonia Dalkin , Rob Anderson , Rachel M. Baker , Cam Donaldson , Vivienne Hibberd , Meghan Bruce Kumar , Felicity Shenton , Gill Westhorp , Geoff Wong , Judy Wright , Angela Bate
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.
{"title":"Bringing together realist and economic approaches in the evaluation of health and social care interventions: a scoping review of theoretical, methodological and practical implications","authors":"Andrew Fletcher , Sonia Dalkin , Rob Anderson , Rachel M. Baker , Cam Donaldson , Vivienne Hibberd , Meghan Bruce Kumar , Felicity Shenton , Gill Westhorp , Geoff Wong , Judy Wright , Angela Bate","doi":"10.1016/j.socscimed.2026.119050","DOIUrl":"10.1016/j.socscimed.2026.119050","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings and recommendations</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119050"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"The widowhood effect across diverse partnerships: Mortality risk after partner loss in same-sex and mixed-sex unions","authors":"Estelle Knoblauch , Stefanie Mollborn , Kaare Christensen , Anna Oksuzyan","doi":"10.1016/j.socscimed.2026.119053","DOIUrl":"10.1016/j.socscimed.2026.119053","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119053"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.socscimed.2026.119026
Yue Zhang , Jingjing Su
Subhealth (亚健康) 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.
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Pub Date : 2026-01-30DOI: 10.1016/j.socscimed.2026.119040
Elizabeth Hornyak-Bell , Aliki Thomas , Allison Chrestensen , Andrea Quaiattini , Patrick Lavoie , Marie-Ève Caty , Marie-Josée Drolet , Annie Rochette , Elizabeth Anne Kinsella
Epistemic injustice, the unfair treatment of individuals in their capacity as knowers, has implications for the credibility, autonomy, and well-being of healthcare professionals. This scoping review addressed the following question: “What is known about epistemic injustice in healthcare professional practice as it relates to the experience of practitioners?”. Guided by Arksey & O'Malley's methodology (2005), we searched eight databases for English and French language publications from 2007 to 2024. Of the 4186 records retrieved, 30 papers met the inclusion criteria. Fifteen papers originated in North America, with twenty-seven published between 2020 and 2024. Epistemic injustice was predominantly conceptualized through Miranda Fricker's constructs of testimonial and hermeneutical injustice, with numerous studies building on or extending Fricker's conceptualizations, and introducing other theorists and evolving concepts. The papers used qualitative research methodologies and theoretical analysis/commentary approaches; none used quantitative or mixed methods designs. Five themes related to epistemic injustice in healthcare professional practice were identified: (1) hierarchy of epistemic credibility, (2) epistemic politics, (3) constrained agency of healthcare practitioners, (4) pressures to modify professional self or identity, and (5) complex interplay of intersectional and social identities. A sixth cross-cutting theme highlighted (6) approaches aimed at mitigating epistemic injustice. The findings highlight the contextual, complex, and often obscure nature of epistemic injustice in the knowledge sharing practices of healthcare professionals. The review underscores the need for a more nuanced and justice-oriented conceptualization of these dynamics, greater visibility of their impact in everyday practice, and structural and educational reforms to foster more equitable knowledge sharing environments.
{"title":"Epistemic injustice in healthcare professional practice: A scoping review","authors":"Elizabeth Hornyak-Bell , Aliki Thomas , Allison Chrestensen , Andrea Quaiattini , Patrick Lavoie , Marie-Ève Caty , Marie-Josée Drolet , Annie Rochette , Elizabeth Anne Kinsella","doi":"10.1016/j.socscimed.2026.119040","DOIUrl":"10.1016/j.socscimed.2026.119040","url":null,"abstract":"<div><div>Epistemic injustice, the unfair treatment of individuals in their capacity as knowers, has implications for the credibility, autonomy, and well-being of healthcare professionals. This scoping review addressed the following question: “What is known about epistemic injustice in healthcare professional practice as it relates to the experience of practitioners?”. Guided by Arksey & O'Malley's methodology (2005), we searched eight databases for English and French language publications from 2007 to 2024. Of the 4186 records retrieved, 30 papers met the inclusion criteria. Fifteen papers originated in North America, with twenty-seven published between 2020 and 2024. Epistemic injustice was predominantly conceptualized through Miranda Fricker's constructs of testimonial and hermeneutical injustice, with numerous studies building on or extending Fricker's conceptualizations, and introducing other theorists and evolving concepts. The papers used qualitative research methodologies and theoretical analysis/commentary approaches; none used quantitative or mixed methods designs. Five themes related to epistemic injustice in healthcare professional practice were identified: (1) hierarchy of epistemic credibility, (2) epistemic politics, (3) constrained agency of healthcare practitioners, (4) pressures to modify professional self or identity, and (5) complex interplay of intersectional and social identities. A sixth cross-cutting theme highlighted (6) approaches aimed at mitigating epistemic injustice. The findings highlight the contextual, complex, and often obscure nature of epistemic injustice in the knowledge sharing practices of healthcare professionals. The review underscores the need for a more nuanced and justice-oriented conceptualization of these dynamics, greater visibility of their impact in everyday practice, and structural and educational reforms to foster more equitable knowledge sharing environments.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119040"},"PeriodicalIF":5.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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