INVESTIGATING THE MECHANISM OF MARITAL MORTALITY REDUCTION: THE TRANSITION TO WIDOWHOOD AND QUALITY OF HEALTH CARE
INVESTIGATING THE MECHANISM OF MARITAL MORTALITY REDUCTION: THE TRANSITION TO WIDOWHOOD AND QUALITY OF HEALTH CARE
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DOI：
10.1353/dem.0.0066
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发表时间：
2009-08-01
期刊：
影响因子：
3.5
通讯作者：
Christakis, Nicholas A.
中科院分区：
文献类型：
--
作者：
Jin, Lei;Christakis, Nicholas A.
虽然众所周知，丧偶妇女的死亡风险增加，但这种生存劣势的机制仍在调查中。在这篇文章中，我们使用了475,313对老年夫妇的独特数据集，对医疗保健质量作为寡妇和死亡率之间的可能联系进行了研究，这些夫妇被随访了长达9年。我们讨论了寡妇的转变是否会影响个人接受的护理质量，并探讨了这些变化在多大程度上调解了寡妇死亡率升高的危险。我们在固定效应框架中分析了六种已建立的卫生保健质量测量方法，以解释未观察到的异质性。在向守寡过渡期间的照顾和严重的丧亲之痛似乎分散了个人在短期内照顾自己保健需求的注意力。然而，丧偶并不会对个人与正规医疗系统保持联系的能力产生长期的不利影响。此外，短期中断并不能调解守寡对死亡率的影响。然而，在配偶死亡后很长一段时间，男性的非正规护理质量、正规和非正规护理之间的协调以及倡导和沟通非正规医疗环境的能力都在下降。这些发现说明了妇女在家庭保健生产中的中心地位，并确定了优化男子适应守寡的重要干预点。
While it is well known that the widowed suffer increased mortality risks, the mechanism of this survival disadvantage is still under investigation. In this article, we examine the quality of health care as a possible link between widowhood and mortality using a unique data set of 475,313 elderly couples who were followed up for up to nine years. We address whether the transition to widowhood affects the quality of care that individuals receive and explore the extent to which these changes mediate the elevated mortality hazard for the widowed. We analyze six established measures of quality of health care in a fixed-effect framework to account for unobserved heterogeneity. Caregiving and acute bereavement during the transition to widowhood appear to distract individuals from taking care of their own health care needs in the short run. However being widowed does not have long-term detrimental effects on individuals 'ability to sustain contact with the formal medical system. Moreover: the short-run disruption does not mediate the widowhood effect on mortality. Nevertheless, long after spousal death, men suffer from a decline in the quality of informal care, coordination between formal and informal care, and the ability to advocate and communicate informal medical settings. These findings illustrate women centrality in the household production of health and identify important points of intervention in optimizing men adjustment to widowhood.