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Using interactions of area dose and individual exposure to estimate effects of population health interventions
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-12 DOI: 10.1016/j.socscimed.2025.117952
Matt Sutton , Samuel Hugh-Jones , Anna Wilding
{"title":"Using interactions of area dose and individual exposure to estimate effects of population health interventions","authors":"Matt Sutton ,&nbsp;Samuel Hugh-Jones ,&nbsp;Anna Wilding","doi":"10.1016/j.socscimed.2025.117952","DOIUrl":"10.1016/j.socscimed.2025.117952","url":null,"abstract":"<div><div>Evaluations of natural experiments in population health studies typically construct and compare exposed and unnexposed populations classified by area or individual exposure. Populations are often dichotomised on one of these dimensions, even if the underlying dose of exposure is graded. We propose that effects of population health interventions can be estimated more accurately by using both dimensions, using an interaction of a continuous measure of dose at area level and the probability of exposure at the individual level. This is particularly useful when receipt of treatment by individuals is either unknown or endogenous. This dose-exposure interaction can be integrated into many common natural experiment designs and we propose it as a <em>verification test</em>. Furthermore, this interaction term can be calibrated to be a predicted probability of exposure and then used to ensure the magnitude of the estimated treatment effect is plausible. We describe how to use this approach and demonstrate its application in two examples: the effects of introducing social prescribing link workers on whether people feel supported by local services; and the effects of a welfare reform on the mental health of benefit claimants. In both cases and in a simulation study, the interactions approach produces more specific, precise and interpretable estimates of intervention effects. We suggest that researchers evaluating population health interventions that are expected to impact on some populations more than others should consider using a dose-exposure interaction design.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117952"},"PeriodicalIF":4.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suicide rates in South Korea and internationally following release of the Netflix series ‘Squid Game’
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-08 DOI: 10.1016/j.socscimed.2025.117934
Mark Sinyor , Sangsoo Shin , Jiyun Lee , Steven Stack , Vera Yu Men , Thomas Niederkrotenthaler
{"title":"Suicide rates in South Korea and internationally following release of the Netflix series ‘Squid Game’","authors":"Mark Sinyor ,&nbsp;Sangsoo Shin ,&nbsp;Jiyun Lee ,&nbsp;Steven Stack ,&nbsp;Vera Yu Men ,&nbsp;Thomas Niederkrotenthaler","doi":"10.1016/j.socscimed.2025.117934","DOIUrl":"10.1016/j.socscimed.2025.117934","url":null,"abstract":"<div><h3>Objective</h3><div>Widely disseminated media depictions of suicide can result in increased suicides, the so-called <em>Werther effect</em>. Season one of the Netflix series <em>Squid Game</em> (SG) was released in September 2021 and contained multiple depictions of suicide, but suicide was not an obvious theme of the show. This study sought to identify whether release of SG resulted in a <em>Werther effect</em>.</div></div><div><h3>Methods</h3><div>We examined changes in suicide rates in the three-month period following release of SG including weekly suicide rates from the country where SG was filmed (South Korea) (2013–2022) and monthly rates from nine comparator countries (Japan, Taiwan, Germany, Spain, UK, USA, Colombia, Mexico, Türkiye) (2015–2022). We conducted interrupted time series (ITS) analyses using quasi-Poisson regression, adjusting for impact of the COVID-19 pandemic, linear trends, and seasonality.</div></div><div><h3>Results</h3><div>There was no evidence of a change in suicides in South Korea in the four weeks after release of SG (IRRs: 0.86, 95% CI 0.71–1.05; 1.13, 95% CI 0.95–1.34; 0.85, 95% CI 0.70–1.02; and 1.08, 95% CI 0.90–1.28, respectively). Age- and sex-stratified results likewise indicated no consistent change in suicide in any specific demographic group. There was no change in monthly suicide rates in the 3-month period following SG in eight of 10 countries with an increase observed in Germany (IRR 1.12, 95% CI 1.03–1.22) and a decrease observed in the UK (IRR 0.88, 95% CI 0.80–0.97).</div></div><div><h3>Conclusions</h3><div>These findings indicate that SG did not produce Werther effects. Further studies are needed to confirm if this finding generally applies to entertainment media where suicides are included but not a major theme.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117934"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relatively independent and complementary roles of family history and polygenic risk score in age at onset and incident cases of 12 common diseases
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-08 DOI: 10.1016/j.socscimed.2025.117942
Wenyan Hou , Yuxin Liu , Xingjie Hao , Jike Qi , Yuchen Jiang , Shuiping Huang , Ping Zeng
{"title":"Relatively independent and complementary roles of family history and polygenic risk score in age at onset and incident cases of 12 common diseases","authors":"Wenyan Hou ,&nbsp;Yuxin Liu ,&nbsp;Xingjie Hao ,&nbsp;Jike Qi ,&nbsp;Yuchen Jiang ,&nbsp;Shuiping Huang ,&nbsp;Ping Zeng","doi":"10.1016/j.socscimed.2025.117942","DOIUrl":"10.1016/j.socscimed.2025.117942","url":null,"abstract":"<div><div>Few studies have systematically compared the overlap and complementarity of family history (FH) and polygenic risk score (PRS) in terms of disease risk. We here investigated the impacts of FH and PRS on the risk of incident diseases or age at disease onset, as well as their clinical value in risk prediction. We analyzed 12 diseases in the prospective cohort study of UK Biobank (<em>N</em> = 461,220). First, restricted mean survival time analysis was performed to evaluate the influences of FH and PRS on age at onset. Then, Cox proportional hazards model was employed to estimate the effects of FH and PRS on the incident risk. Finally, prediction models were constructed to examine the clinical value of FH and PRS in the incident disease risk. Compared to negative FH, positive FH led to an earlier onset, with an average of 2.29 years earlier between the top and bottom 2.5% PRSs and high blood pressure showing the greatest difference of 6.01 years earlier. Both FH and PRS were related to higher incident risk; but they only exhibited weak interactions on high blood pressure and Alzheimer's disease/dementia, and provided relatively independent and partially complementary information on disease susceptibility, with PRS explaining 7.0% of the FH effect but FH accounting for only 1.1% of the PRS effect for incident cases. Further, FH and PRS showed additional predictive value in risk evaluation, with breast cancer showing the greatest improvement (31.3%). FH and PRS significantly affect a variety of diseases, and they are not interchangeable measures of genetic susceptibility, but instead offer largely independent and partially complementary information. Incorporating FH, PRS, and clinical risk factors simultaneously leads to the greatest predictive value for disease risk assessment.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117942"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591582","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}
引用次数: 0
Methodologies and estimates of social costs of gambling: A scoping review
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-08 DOI: 10.1016/j.socscimed.2025.117940
Sari Hautamäki , Virve Marionneau , Sari Castrén , Jussi Palomäki , Susanna Raisamo , Tomi Lintonen , Pia Pörtfors , Tiina Latvala
{"title":"Methodologies and estimates of social costs of gambling: A scoping review","authors":"Sari Hautamäki ,&nbsp;Virve Marionneau ,&nbsp;Sari Castrén ,&nbsp;Jussi Palomäki ,&nbsp;Susanna Raisamo ,&nbsp;Tomi Lintonen ,&nbsp;Pia Pörtfors ,&nbsp;Tiina Latvala","doi":"10.1016/j.socscimed.2025.117940","DOIUrl":"10.1016/j.socscimed.2025.117940","url":null,"abstract":"<div><div>The definition and measurement of social costs has been debated in gambling literature. Predominant framings of gambling have depicted it as a leisure activity without significant costs other than those caused directly by problem gambling. This view has been recently challenged with a public health perspective, adopting a wider definition of social costs that span beyond issues related to treatment and crime.</div><div>Definitional debates have resulted in highly heterogenous approaches to calculating the social costs of gambling. The aim of this review is, first, to assess the kind of costs that have been included in existing estimates; second, to compare overall estimates of social costs; and third, to compare methodological differences.</div><div>We conducted a scoping review following the Joanna Briggs Institute guidelines for scoping reviews, using the PRISMA-SCR/P tool. The literature search included both peer reviewed publications and grey literature and was conducted in June 2023 and repeated in March 2024. After screening, 26 references were included in the review.</div><div>Estimates in the included studies contained direct costs, such as crime and law enforcement, financial counselling, and treatment-related costs. Indirect cost included items such as health and social care, unemployment, and financial cost of divorce. Intangible costs included, for example, quantifications of suicide, emotional distress, and relationship problems. The number of included cost items varied across studies from 5 to 32. We identified seven different methodological approaches to calculating costs. Total estimates using different approaches varied greatly, ranging from 6 to 324,000 million int$ total, with an average of 3,980 int$ per adult and median 449 int$ per adult.</div><div>We conclude that the high variation in available total estimates is due to differences in number of cost items and methodological approaches. The results highlight the need for consistent international guidelines for calculating the total social cost of gambling.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117940"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995–2020
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-07 DOI: 10.1016/j.socscimed.2025.117905
Tsai-Chin Cho , Xuexin Yu , Sara D. Adar , HwaJung Choi , Kenneth M. Langa , Lindsay C. Kobayashi
{"title":"Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995–2020","authors":"Tsai-Chin Cho ,&nbsp;Xuexin Yu ,&nbsp;Sara D. Adar ,&nbsp;HwaJung Choi ,&nbsp;Kenneth M. Langa ,&nbsp;Lindsay C. Kobayashi","doi":"10.1016/j.socscimed.2025.117905","DOIUrl":"10.1016/j.socscimed.2025.117905","url":null,"abstract":"<div><h3>Objectives</h3><div>A negative wealth shock, defined as a loss of ≥75% in equivalized household total wealth over a short period, may cause adverse health outcomes for older adults. The individual-level risk factors for experiencing a negative wealth shock in later adulthood are unclear.</div></div><div><h3>Methods</h3><div>Data were from 25,072 adults aged ≥55 in the longitudinal, population-based US Health and Retirement Study from 1995 to 2020 (n = 123,651 observations across all study respondents). We performed multivariable-adjusted Poisson mixed effects models to examine the association of each of the four risk factors, 1) separation from or loss of a spouse/partner; 2) transition from better to worse self-reported general health; 3) transition from low to high depressive symptoms; and 4) transition from normal cognition to cognitive impairment without dementia (CIND) or dementia, with the subsequent experience of a negative wealth shock in mid-to-later life.</div></div><div><h3>Results</h3><div>All four risk factors increased the likelihood of newly experiencing a negative wealth shock: separation from or loss of a spouse/partner (incidence rate ratio (IRR) = 1.59; 95% CI: 1.41, 1.78), transition from excellent/good to fair/poor self-reported general health (IRR = 1.14; 95% CI: 1.06, 1.23), transition from low to high depressive symptoms (IRR = 1.10; 95% CI: 1.02, 1.19), and transition from normal to CIND or dementia (IRR = 1.14; 95% CI: 1.06, 1.22).</div></div><div><h3>Discussion</h3><div>This long-timespan, population-based study suggests that adverse changes in marital or health status in mid-to-later life may signal risks for a future negative wealth shock. Public policy interventions to support aging adults at risk of a negative wealth shock may be warranted.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117905"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591491","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}
引用次数: 0
Testing “the science”: A comparative analysis of COVID-19 testing policy across four Canadian provinces
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-07 DOI: 10.1016/j.socscimed.2025.117880
Katherine Fierlbeck , Lara Gautier , Susan Usher , Sara Allin , Veena Sriram , Peter Berman
{"title":"Testing “the science”: A comparative analysis of COVID-19 testing policy across four Canadian provinces","authors":"Katherine Fierlbeck ,&nbsp;Lara Gautier ,&nbsp;Susan Usher ,&nbsp;Sara Allin ,&nbsp;Veena Sriram ,&nbsp;Peter Berman","doi":"10.1016/j.socscimed.2025.117880","DOIUrl":"10.1016/j.socscimed.2025.117880","url":null,"abstract":"<div><div>Following the COVID-19 pandemic, scholarship has focused on the intersection of politics and scientific evidence in the development, distribution and uptake of vaccines; border closures; and interventions such as public space closures or masking. But there is a significant gap in the examination of the political choices which informed how discrete jurisdictions chose to undertake and support COVID-19 testing. Using a qualitative, multiple-case study nested in a larger comparative, mixed-method explanatory case study, this research addresses this gap in the literature through a qualitative analysis based on 103 key stakeholder interviews to inform the narrative of testing strategy across four Canadian provinces. Despite the perception that testing is a largely “scientific” process relatively insulated from political choices and pressures, this study shows that jurisdictions had to address an array of variables, often specific to their region, which strongly influenced policy choices in this area. Testing policy, rather than a simple and straightforward clinical exercise, is a highly complex and nuanced process that must take into account a wide variety of non-clinical variables.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117880"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using spatial Bayesian models to estimate associations between structural racial discrimination and disparities in severe maternal morbidity
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-07 DOI: 10.1016/j.socscimed.2025.117932
Jasmin A. Darville , Katherine Campbell , Kaitlyn K. Stanhope , Alexis Kendall , Sierra Carter , Michael R. Kramer , Ran Zhang , Sheree L. Boulet
{"title":"Using spatial Bayesian models to estimate associations between structural racial discrimination and disparities in severe maternal morbidity","authors":"Jasmin A. Darville ,&nbsp;Katherine Campbell ,&nbsp;Kaitlyn K. Stanhope ,&nbsp;Alexis Kendall ,&nbsp;Sierra Carter ,&nbsp;Michael R. Kramer ,&nbsp;Ran Zhang ,&nbsp;Sheree L. Boulet","doi":"10.1016/j.socscimed.2025.117932","DOIUrl":"10.1016/j.socscimed.2025.117932","url":null,"abstract":"<div><h3>Introduction</h3><div>The United States maternal health crisis is especially profound in Georgia, disproportionately affecting Black birthing people. In Georgia, 35% of all births are to Black-identifying people, with rates of severe maternal morbidity (SMM) significantly exceeding national averages.</div></div><div><h3>Methods</h3><div>The sample population comprised Georgia linked live birth/fetal death certificate and hospital discharge data for deliveries from 2013 to 2021. Structural racial discrimination (SRD) was defined at the county level using four domains. We estimated county-specific rates of SMM using Bayesian conditional autoregressive Poisson models and compared the rate difference in SMM for Black versus white birthing people across domain-specific strata of SRD.</div></div><div><h3>Results</h3><div>The sample included 709,335 deliveries to Black and white birthing people. The prevalence of SMM was higher among births to Black individuals compared to white counterparts (3.2% vs. 1.7%), with a mean risk difference of 13.1 per 1000 deliveries between race groups. Results of the SRD-SMM regression demonstrated larger Black-white racial disparities in counties with the highest concentration of resource deprivation compared to the highest concentration of affluence (B: 4.5, 95% CI: 1.1, 8.0). Similarly, in counties with a greater polarization of Black and low-income residents, the disparity was larger compared to counties with greater racial and income homogeneity (B: 3.84, 95% CI: 0.22, 7.44).</div></div><div><h3>Conclusions</h3><div>Our results highlight the nuanced relationship between structural racism and health outcomes in Georgia. SMM rates were higher among Black birthing people compared to their white counterparts.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117932"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601243","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}
引用次数: 0
Exploring the drivers of unsustainable pressures in health and social care: A qualitative system dynamics approach
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-07 DOI: 10.1016/j.socscimed.2025.117913
Le Khanh Ngan Nguyen , Holly McCabe , Susan Howick , Itamar Megiddo , Soumen Sengupta , Alec Morton
{"title":"Exploring the drivers of unsustainable pressures in health and social care: A qualitative system dynamics approach","authors":"Le Khanh Ngan Nguyen ,&nbsp;Holly McCabe ,&nbsp;Susan Howick ,&nbsp;Itamar Megiddo ,&nbsp;Soumen Sengupta ,&nbsp;Alec Morton","doi":"10.1016/j.socscimed.2025.117913","DOIUrl":"10.1016/j.socscimed.2025.117913","url":null,"abstract":"<div><div>Health and social care systems face immense pressures that emerge from complex interdependencies between system components, transcending conventional explanations of demand-capacity mismatches. Although multiple theoretic perspectives (e.g., “complex adaptive systems”, “sociotechnical systems”) have been advocated as ways to capture and characterise the nature of that complexity, consolidating it into actionable insights for coordinated stakeholder efforts remains challenging, perpetuating implementation failure. This study introduces a novel application of qualitative system dynamics, using Causal Loop Diagrams (CLDs), to reveal the deeper structural patterns that drive persistent challenges and explain why policies have often fallen short.</div><div>Developed through stakeholder interviews in South Lanarkshire, Scotland (24 interviews conducted between February and June 2023), triangulated with UK-wide evidence, our CLD reveals how well-intentioned interventions generate cross-sectoral ripple effects. While stakeholders may recognise isolated consequences, organisational silos and temporal delays obscure the full complexity of feedback structures. Our findings expose inherent trade-offs, demonstrating how multiple, competing perspectives and reactive coping measures create emergent system properties that fundamentally challenge the oversimplified notion of “whole system working”, often hailed as a “magic bullet” solution. Significantly, we uncover a paradoxical tension: cross-sector collaboration initiatives can undermine personalised care delivery, highlighting the risk of conflicting strategic and political goals weakening intended outcomes.</div><div>Our study advances system dynamics methodology by combining individual and cascaded system archetypes, enhancing clarity in communication of complex issues without losing critical feedback loops. This advancement provides decision-makers with a sophisticated yet accessible tool to visualise and understand complex system behaviour, engaging stakeholders through iterative feedback loop refinements, and steering towards an equitable, improved state.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117913"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Family participation in geriatric decision-making: Marginalization of older patients’ autonomy in Chinese outpatient consultation
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-06 DOI: 10.1016/j.socscimed.2025.117908
Tianxin Yan, Min Yang
{"title":"Family participation in geriatric decision-making: Marginalization of older patients’ autonomy in Chinese outpatient consultation","authors":"Tianxin Yan,&nbsp;Min Yang","doi":"10.1016/j.socscimed.2025.117908","DOIUrl":"10.1016/j.socscimed.2025.117908","url":null,"abstract":"<div><div>Family participation is regarded as crucial for promoting patient well-being, particularly in geriatric care, where patients often face greater challenges and require additional support in making medical decisions. The importance of family participation is frequently framed within a cultural context that acknowledges differing conceptions of autonomy. However, it remains unclear how family members are actually prompted or discouraged in their participation in medical decision-making. This article aims to identify the interactional patterns of decision-making during accompanied geriatric consultations and to examine the underlying mechanisms shaping these dynamics. Focusing on audio recordings of 86 geriatric encounters, the mixed-method study identified four decision-making patterns through nuanced Conversation Analysis: <em>direct family surrogation, substitute family surrogation</em>, and <em>patient-centered collaboration</em>. A subsequent quantitative analysis was conducted to explore factors influencing these decision-making patterns, in which the identity of the companion emerged as a key factor shaping interactional dynamics, with adult children being significantly more likely to assume a surrogate role than spouses. These findings are discussed in the context of the broader social structure of elder care and the institutional constraints present in the Chinese medical system. This study emphasizes the need for caution in overemphasizing cultural characteristics, as doing so risks systematically marginalizing the social agency and self-efficacy of older adults. We call for greater efforts to ensure the meaningful participation of older individuals in healthcare decisions.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117908"},"PeriodicalIF":4.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621304","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}
引用次数: 0
Health disparity among older adults in Urban China: Does labor migration Matter?
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-05 DOI: 10.1016/j.socscimed.2025.117925
Zehan Pan , Feiyang Yang , Nan Yang , Riming Nie
{"title":"Health disparity among older adults in Urban China: Does labor migration Matter?","authors":"Zehan Pan ,&nbsp;Feiyang Yang ,&nbsp;Nan Yang ,&nbsp;Riming Nie","doi":"10.1016/j.socscimed.2025.117925","DOIUrl":"10.1016/j.socscimed.2025.117925","url":null,"abstract":"<div><div>China has seen a surge in labor migration and widening regional health disparities among urban older residents since the late 1990. However, the relationship between labor migration and these disparities remains unknown. This study employs the shift-share instrument method to explore the association between labor migration and the self-rated health among urban older residents with the microdata from the 1% National Population Sample Survey (2005 and 2015) and provincial panel data (2010–2020). The results indicate that regions with higher net labor inflow exhibit improved average health levels and reduced health inequality among local older adults with varying socioeconomic statuses. Between 2010 and 2015, labor migration led to a 9.21 percentage point increase in the regional disparity of self-rated “healthy” probabilities among urban older residents. The key mechanism underlying these effects is the positive effects of labor migration on the wellbeing of certain group of urban older residents. The findings of this study suggest that social benefits access inequality between migrants and non-migrants, and the health disparities among urban older adults underscore broader structural inequality in China.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117925"},"PeriodicalIF":4.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578441","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}
引用次数: 0
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