Social Science & Medicine最新文献_第6页

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 : 2026-01-25 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

Corrigendum to ‘Parenthood and mental health: Findings from an English longitudinal cohort aged 32’ [Soc. Sci. Med. Volume 383, October 2025, 118471] 《为人父母与心理健康：来自英国32岁纵向队列的调查结果》的更正[Soc]。科学。Med.卷383，十月2025,118471]。

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

Social Science & Medicine

Pub Date : 2026-01-24 DOI: 10.1016/j.socscimed.2026.119011

Rosie Mansfield, Morag Henderson

引用次数: 0

Corrigendum to ‘No one wants to be a good patient: Intersectionality and agency in the sick role’ [Soc. Sci. Med. Volume 382, October 2025, 118372] 《没有人想成为一个好病人：病人角色的交叉性和能动性》的更正[Soc]。科学。Med.卷382，十月2025,118372]。

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

Social Science & Medicine

Pub Date : 2026-01-24 DOI: 10.1016/j.socscimed.2026.119013

Weiwei Lu

引用次数: 0

Risk adjustment to improve fairness and efficiency of resource allocation: a case from the Emilia Romagna region in the decentralized Italian SSN 通过风险调整提高资源分配的公平性和效率：以意大利社会保障体系分散化的艾米利亚-罗马涅地区为例。

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

Social Science & Medicine

Pub Date : 2026-01-24 DOI: 10.1016/j.socscimed.2026.119032

Josefa Henriquez , Gianluca Fiorentini , Francesco Paolucci

Resource allocation formulas in National Health Systems (NHS) are crucial for distributing central funds to Regions/Local Health Authorities. However, under prospective capitation funding, resource constraints may generate incentives for selective rationing, as providers seek to contain costs within fixed budgets. While NHS features such as geographically based enrolment and funding limit explicit risk selection seen in competitive insurance markets, resource scarcity can lead to rationing in socially suboptimal ways, which might disproportionately affect vulnerable populations. This paper aims to quantify selective rationing incentives using the healthcare system in the Emilia-Romagna Region in Italy as a case study. We evaluate the current funding formula used in Italy and its impact on the Region and demonstrate how alternative formulas can be developed to minimize incentives for selective rationing in the Region while remaining feasible to implement, given heterogeneous data quality and availability across Regions that hinder formula development at a national level. Our results show that the current formula undercompensates specific population groups defined by age and sex and has inadequate responsiveness to need. Alternative formulas that risk-adjust using socioeconomic variables have low statistical fit but reduce funding disparities among deprived areas/poorer individuals. Nevertheless, they are less responsive to high-need individuals. Moreover, morbidity data, even at coarse granularity, contribute to more adequately funding high-cost groups like cancer patients. To explore broader implications, we simulate how these alternative formulas would alter allocations if applied at the national level, showing that accounting for risk variation would channel more resources to the Regions in need. Overall, we provide a rationale for transitioning from the current resource allocation formula to risk adjustment to reduce potential selective rationing incentives.

国家卫生系统（NHS）的资源分配公式对于向地区/地方卫生当局分配中央资金至关重要。然而，在预期的人头供资情况下，资源限制可能促使选择性配给，因为供应者设法将费用控制在固定预算之内。虽然NHS的特点，如基于地理位置的注册和资金限制了竞争保险市场中明确的风险选择，但资源稀缺可能导致以社会次优方式配给，这可能会不成比例地影响弱势群体。本文旨在量化选择性配给激励使用在艾米利亚-罗马涅地区的医疗保健系统在意大利作为一个案例研究。我们评估了意大利目前使用的供资公式及其对该区域的影响，并展示了如何制定替代公式，以最大限度地减少该区域选择性定量配给的激励，同时保持实施的可行性，因为各区域的数据质量和可用性存在差异，阻碍了国家一级的公式制定。我们的研究结果表明，目前的公式补偿不足的特定人口群体定义的年龄和性别，并没有充分的响应需求。使用社会经济变量进行风险调整的替代公式的统计拟合度较低，但减少了贫困地区/较贫困个人之间的资金差距。然而，他们对高需求个体的反应较差。此外，即使是粗粒度的发病率数据，也有助于更充分地资助癌症患者等高成本群体。为了探索更广泛的影响，我们模拟了如果在国家一级应用这些替代公式将如何改变分配，表明考虑风险变化将为有需要的区域提供更多资源。总的来说，我们提供了一个从当前资源分配公式到风险调整以减少潜在的选择性配给激励的基本原理。

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引用次数: 0

Legal but informal abortion: Reproductive governance and health(care) in Ulaanbaatar, Mongolia 合法但非正式的堕胎：蒙古乌兰巴托的生殖管理和保健（护理）

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

Social Science & Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.socscimed.2026.118983

Mari Valdur

Abortion has been legal in Mongolia since 1989, yet a significant number of abortions are informal. The article unfolds the pro-natalist (geo-)biopolitical discourses presented by the head of the state, arguing that these are disconnected from why informal abortions occur. It provides an overview of Mongolia's abortion legislation and reviews informal abortion economies, including abortion medication and clinical abortion. The lack of distinction between formal and informal services, and the affective qualities of the health(care) system, are shaped by the broader governance of healthcare, including top-down structural adjustment programs. As a result, doctors are often overworked and underpaid, while possessing significant power over doctor-patient relationships and the pricing of services. The article demonstrates that informal abortions are linked to the overall governance of healthcare, informal economies, and often extremely dire economic situation of those involved. Meanwhile, the shaming rhetoric about abortion obscures attention and accountability from the often adverse workings of reproductive governance, effectively criminalizing those most disadvantaged by it. The paper draws on media and discourse analysis, and over 20 semi-structured interviews with women, medical professionals, and others involved in informal abortion economies. The multi-sited ethnographic fieldwork was carried out in Ulaanbaatar, Mongolia, over 15 months in 2017–2018, and during one-month follow-up visits in August 2019 and 2022.

自1989年以来，堕胎在蒙古是合法的，但相当多的堕胎是非正式的。这篇文章展开了国家元首提出的亲生育主义（地缘）生物政治话语，认为这些话语与非正式堕胎发生的原因是脱节的。它概述了蒙古的堕胎立法，并审查了非正规堕胎经济，包括堕胎药物和临床堕胎。正规和非正规服务之间缺乏区别，以及卫生（保健）系统的情感质量，是由更广泛的医疗保健治理形成的，包括自上而下的结构调整计划。因此，医生往往工作过度，收入过低，同时在医患关系和服务定价方面拥有很大的权力。这篇文章表明，非正规堕胎与医疗保健、非正规经济的总体治理以及相关人员往往极其糟糕的经济状况有关。与此同时，关于堕胎的可耻言论掩盖了人们对生殖管理的关注和责任，这些管理往往是不利的，有效地将那些最弱势的人定为犯罪。本文借鉴了媒体和话语分析，以及对妇女、医疗专业人员和其他参与非正式堕胎经济的人进行的20多次半结构化采访。2017-2018年在蒙古乌兰巴托进行了为期15个月的多地点人种学实地调查，并于2019年8月和2022年8月进行了为期一个月的随访。

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引用次数: 0

Religiosity and justification of euthanasia: multilevel moderation of beliefs in life after death 安乐死的宗教性与正当性：死后生命信仰的多层次节制。

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

Social Science & Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.socscimed.2026.119024

Bruno Frutuoso Costa , Helena Carvalho

Although research consistently shows that both individual and national religiosity are negatively associated with the justification of euthanasia, there is a lack of knowledge about the moderators of this relationship. Beliefs in life after death provide a framework for attributing meaning beyond earthly existence. Using data from the most recent wave of the European Values Study project (EVS, 2022), this study examined how such beliefs in life after death relate to the justification of euthanasia and moderate the religiosity-euthanasia relationship at both individual and cultural levels in a cross-national context. A multilevel analysis of 35 countries and approximately 48,000 participants revealed that both religiosity and beliefs in life after death significantly increased opposition to euthanasia. Moreover, beliefs in life after death strengthened the negative association between religiosity and the justification of euthanasia. Findings suggest that these beliefs in life after death operate simultaneously at the individual and cultural levels. These results highlight the importance of multilevel approaches to understanding end-of-life attitudes and underscore the need for public health policies to consider cultural beliefs about death when addressing euthanasia legislation and clinical decision-making.

尽管研究一致表明，个人和国家的宗教信仰都与安乐死的正当性呈负相关，但人们对这种关系的调节因素缺乏了解。对死后生命的信仰提供了一个框架，赋予超越尘世存在的意义。利用最新一波欧洲价值观研究项目（EVS, 2022）的数据，本研究在跨国背景下，从个人和文化层面考察了这种对死后生命的信仰与安乐死的合理性之间的关系，并缓和了宗教与安乐死之间的关系。一项针对35个国家约48000名参与者的多层次分析显示，宗教信仰和对死后生命的信仰都显著增加了对安乐死的反对。此外，对死后生命的信仰强化了宗教虔诚度与安乐死正当性之间的负相关关系。研究结果表明，这些对死后生命的信念在个人和文化层面上同时起作用。这些结果强调了多层次方法对理解临终态度的重要性，并强调了公共卫生政策在处理安乐死立法和临床决策时考虑死亡文化信仰的必要性。

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引用次数: 0

Loneliness predicts mortality risk via the erosion of purpose in life 孤独通过对生活目标的侵蚀来预测死亡风险

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

Social Science & Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.socscimed.2026.119008

Páraic S. O'Súilleabháin , Emma M. Kirwan , Milou Fredrix , Martina Luchetti , Damaris Aschwanden , Máire McGeehan , Angelina R. Sutin , Antonio Terracciano , Yannick Stephan , Gráinne McKenna

Loneliness is associated with premature mortality risk. Less is known about the mechanisms that may explain this association. Given its consequential health associations and relation to loneliness, purpose in life may be one such mechanism. In a prospective rotating split-sample design from 2008-2010 to 2012-2014 with 11 years of mortality status follow-up, we tested purpose in life as an indirect pathway between loneliness and future risk of death. Participants were from the Health and Retirement Study in the United States (N = 8351; M[SD] = 67.9 [9.19] years; range: 50–101; 60 % female; n = 1191 deceased). Purpose in life explained an estimated 88 % of the association between loneliness and mortality risk, with the majority of the mediated association appearing to reflect changes in purpose in life over time. These effects were independent of loneliness change during follow-up and initial levels of purpose in life. This indirect path was robust to sensitivity analyses, and further adjustment for conceptually similar constructs, such as depression, social isolation, and neuroticism. A supplemental model that tested purpose in life as the antecedent and loneliness as the indirect pathway indicated substantially smaller effects. Much of loneliness-mortality relation operated through purpose in life. Purpose in life appears to be a critical factor in the context of loneliness. It may prove fruitful to pay particular attention to the individual, community, and broader societal sources of purpose in life when looking to ameliorate the effect of loneliness on health.

孤独与过早死亡风险有关。对于解释这种关联的机制，人们所知甚少。鉴于其对健康的影响以及与孤独的关系，生活目标可能就是这样一种机制。在2008-2010年至2012-2014年的前瞻性旋转分裂样本设计中，我们对11年的死亡率状况进行了随访，我们测试了生活目的作为孤独与未来死亡风险之间的间接途径。参与者来自美国健康与退休研究（N = 8351;M[SD] = 67.9[9.19]岁；范围：50-101；60 %女性；N = 1191例死亡）。生活目标解释了大约88 %的孤独和死亡风险之间的关联，其中大多数中介关联似乎反映了随着时间的推移生活目标的变化。这些影响与孤独感在随访和生活目标初始水平的变化无关。这种间接路径对于敏感性分析和进一步调整概念上相似的结构（如抑郁、社会隔离和神经质）是稳健的。一个补充模型测试了生活中的目标作为前因由和孤独作为间接途径，结果表明影响要小得多。许多孤独与死亡的关系是通过生活的目标来实现的。生活的目标似乎是孤独的一个关键因素。在寻求改善孤独对健康的影响时，特别关注个人、社区和更广泛的社会目标来源可能是富有成效的。

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引用次数: 0

The connections among interactions with nature, diet quality, and sustainable eating: Insights from a mixed methods study 与自然互动、饮食质量和可持续饮食之间的联系：来自混合方法研究的见解

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

Social Science & Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.socscimed.2026.119014

Dahlia Stott , Michael Bruneau Jr. , Jonathan M. Deutsch , Rebecca Ippolito , DeAndra Forde , Mara Z. Vitolins , Jennifer A. Nasser , Brandy-Joe Milliron

Interacting with nature, such as spending time in nature and having houseplants, has been associated with positive mental and physical health outcomes and behaviors but limited research has explored dietary behaviors. Therefore, this study examined the relationships among interactions with nature, diet quality, and sustainable dietary patterns. In this explanatory sequential mixed methods study, participants self-reported the frequency and duration of their interactions with nature and completed Diet History Questionnaire II, where Healthy Eating Index-2020 (diet quality) and EAT-Lancet Index (sustainable dietary pattern) scores were calculated. A purposive sample of participants completed an interview. Multiple regression models were used to analyze quantitative data. Qualitative data were thematically analyzed. The data were integrated by connecting and merging. Three hundred adults completed the survey and 30 were interviewed. Positive significant relationships among interactions with nature, diet quality (p < .001), and sustainable dietary patterns (p < .001) were found. Four themes highlighted how interacting with nature may affect dietary intake: engaging with the natural world relaxes the mind, paving the way for healthier eating habits; pursuing health draws us toward nature and positively influences dietary choices; a deep connection to nature sparks a desire to nourish the body with more fruits and vegetables; and thoughtfully participating in the food system promotes healthier choices for personal and planetary health. Integrated findings highlight that mental state moderates and connection to nature mediates the relationships of interest. These results may be used to promote dietary behaviors for personal and planetary health through nature-based interventions.

与自然互动，如花时间在大自然中，种植室内植物，与积极的身心健康结果和行为有关，但对饮食行为的研究有限。因此，本研究考察了与自然的相互作用、饮食质量和可持续饮食模式之间的关系。在这项解释性顺序混合方法研究中，参与者自我报告了他们与自然互动的频率和持续时间，并完成了饮食史问卷II，其中计算了健康饮食指数-2020（饮食质量）和EAT-Lancet指数（可持续饮食模式）得分。有目的的参与者样本完成了一次访谈。采用多元回归模型对定量数据进行分析。对定性数据进行专题分析。数据通过连接和合并进行整合。300名成年人完成了这项调查，其中30人接受了采访。与自然的互动、饮食质量（p < 0.001）和可持续饮食模式（p < 0.001）之间存在显著正相关。四个主题强调了与自然互动如何影响饮食摄入：与自然世界接触可以放松大脑，为养成更健康的饮食习惯铺平道路；对健康的追求将我们引向自然，并对饮食选择产生积极影响；与自然的深层联系激发了用更多水果和蔬菜滋养身体的欲望；深思熟虑地参与食品系统，促进个人和地球健康的更健康选择。综合研究结果强调，精神状态调节兴趣关系，与自然的联系调节兴趣关系。这些结果可用于通过基于自然的干预措施促进个人和地球健康的饮食行为。

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引用次数: 0

Adolescence in social context: Longitudinal associations of 15 social factors with health and well-being 社会背景下的青少年：15个社会因素与健康和幸福的纵向关联。

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

Social Science & Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.socscimed.2026.118993

Renae Wilkinson , Eric S. Kim , Ying Chen , Julianne Holt-Lunstad , Tyler J. VanderWeele

Concern is growing that social disconnection poses serious risks to health and well-being, especially for adolescents. Yet without clear evidence on which relational factors (e.g., parent-child, sibling, romantic, and friend relationships; connectedness to families, schools, and neighborhoods) matter most, designing effective, developmentally attuned interventions remains difficult. To address this question, we used data from a large, nationally representative sample of U.S. adolescents (Add Health) and an outcome-wide approach to prospectively test whether one-year changes (between Wave I: 1994–1995 and Wave II: 1996) in 15 social factors, spanning structural, functional, and quality domains, were associated with 34 indicators of health and well-being 11.37 years later (in Wave IV: 2008, N = 11,040) or 20.64 years later (in Wave V: 2016–2018, N = 9003), adjusting for an extensive set of covariates. The outcome-wide framework fits a series of regression models for the relationship between one predictor and a set of outcomes (one outcome analyzed at a time), adjusting for the same set of covariates in each regression model. Six factors (school connectedness, loneliness, emotional support, neighborhood cohesion, religious service attendance, and family cohesion) showed associations with at least one-quarter of outcomes. Associations were most consistent in psychological well-being, mental health, and civic/prosocial domains. Strengthening school connectedness and emotional support, and reducing loneliness, appear especially promising for fostering long-term health.

人们越来越担心，与社会脱节对健康和福祉构成严重威胁，特别是对青少年而言。然而，没有明确的证据表明哪些关系因素（例如，亲子、兄弟姐妹、浪漫和朋友关系；与家庭、学校和社区的联系）最重要，设计有效的、与发展相适应的干预措施仍然很困难。为了解决这个问题，我们使用了来自美国青少年的大型全国代表性样本的数据（添加健康）和结果范围的方法来前瞻性地测试15个社会因素的一年变化（第一波：1994-1995年和第二波：1996年），跨越结构，功能和质量领域，是否与11.37年后（第四波：2008年，N = 11040）或20.64年后（第五波：2008年）的34个健康和福祉指标相关。2016-2018, N = 9003)，调整了广泛的协变量集。结果范围框架适用于一个预测器和一组结果（一次分析一个结果）之间关系的一系列回归模型，并对每个回归模型中的同一组协变量进行调整。六个因素（学校联系、孤独感、情感支持、邻里凝聚力、宗教服务出席率和家庭凝聚力）与至少四分之一的结果相关。关联在心理健康、心理健康和公民/亲社会领域最为一致。加强学校联系和情感支持，减少孤独感，似乎对促进长期健康尤其有希望。

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引用次数: 0

Adverse childhood experiences and all-cause mortality in older Japanese adults: a 6-year prospective cohort study, modified by marital status 日本老年人不良童年经历和全因死亡率：一项受婚姻状况影响的6年前瞻性队列研究

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

Social Science & Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.socscimed.2026.119012

Tomoki Kawahara , Yukako Tani , Katsunori Kondo , Takeo Fujiwara

Objectives

Adverse childhood experiences (ACEs) are known to be associated with morbidity and premature death, but the association between ACEs and mortality among older people is unknown in Japan, and whether marital status modifies the associations remains unclear.

Methods

We analyzed data from 12,698 older adults (65+ years) participating in the Japan Gerontological Evaluation Study (JAGES; response rate 70.3 %) in 2013 and were followed for 6 years. ACEs and marital status were assessed at baseline, and mortality was prospectively followed. Cox proportional hazards models were used to assess the association between ACEs and mortality, stratified by sex and marital status adjusted for covariates.

Results

1948 deaths occurred during the follow-up (Men: 1,238, Women: 710). We found no association between ACEs and mortality overall for both sexes. When stratified by marital status, among divorced/unmarried men, those having 3+ ACEs were 4.00 times more likely to die (95 % CI: 1.46–10.95), although there was no association between ACEs and mortality among married men. In contrast, among divorced/unmarried women, having ACEs showed a lower risk of mortality, and married women also showed no association between ACEs and mortality.

Discussion

ACEs were associated with mortality among divorced/unmarried older men, which is not true for married men and all women. Further research is warranted to elucidate the mechanism to prevent the adverse effect of ACEs on mortality among divorced/unmarried men and all women.

目的儿童不良经历（ace）已知与发病率和过早死亡相关，但在日本，ace与老年人死亡率之间的关系尚不清楚，婚姻状况是否会改变这种关联尚不清楚。方法分析2013年参加日本老年学评价研究（JAGES，有效率70.3%）的12698名65岁以上老年人的数据，随访6年。基线时评估ace和婚姻状况，并对死亡率进行前瞻性随访。使用Cox比例风险模型评估ace与死亡率之间的关系，并按性别和婚姻状况分层，调整协变量。结果随访期间死亡1948例（男性1238例，女性710例）。我们没有发现ace与两性总体死亡率之间的联系。当按婚姻状况分层时，在离婚/未婚男性中，有3+ ace的人死亡的可能性是4.00倍（95% CI: 1.46-10.95），尽管在已婚男性中ace和死亡率之间没有关联。相比之下，在离婚/未婚女性中，有ace的死亡风险较低，已婚女性也没有显示ace与死亡率之间的关联。在离异/未婚的老年男性中，ace与死亡率有关，但这并不适用于已婚男性和所有女性。在离婚/未婚男性和所有女性中，需要进一步的研究来阐明预防ace对死亡率不利影响的机制。

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引用次数: 0