Structure Widowhood Effect on Medical Utilization: Bereaved or Unprotected

Structure Widowhood Effect on Medical Utilization: Bereaved or Unprotected | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Structure Widowhood Effect on Medical Utilization: Bereaved or Unprotected Zhiyao Hu, Leiqiang Cui, Li Zhao, Zhiqiang Feng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9135913/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Family health behaviors are increasingly recognized as critical determinants of healthcare utilization. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that inpatient care usage significantly increases after spousal loss, while outpatient care remains stable. To explain this divergence, we examine health status and chronic disease management among the widowed, finding they experienced poorer health outcomes and reduced access to routine care. Lacking spousal support and monitoring, widowed individuals often fail to adhere to medications, even if diagnosed, leading to preventable disease progression and hospitalization. Our findings highlight that, in addition to the well-documented bereaved effect, the unprotected effect –loss of marriage’s protective health behaviors – is also a crucial determinant of increased medical utilization following widowhood. In developing countries with weak primary care systems, this shift may divert manageable outpatient cases to costlier inpatient care, imposing additional burden on healthcare. Widowhood effect Medical care utilization Bereaved effect Marriage protection Health behavior Full Text Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 16 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9135913","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631853496,"identity":"91abf1e2-7dca-4ad8-9b14-a1e8dceb215b","order_by":0,"name":"Zhiyao Hu","email":"","orcid":"","institution":"University of Chinese Academy of Social Science","correspondingAuthor":false,"prefix":"","firstName":"Zhiyao","middleName":"","lastName":"Hu","suffix":""},{"id":631853499,"identity":"0fda8645-de9f-43c7-995a-5f4e3100330b","order_by":1,"name":"Leiqiang Cui","email":"","orcid":"","institution":"Peking University","correspondingAuthor":false,"prefix":"","firstName":"Leiqiang","middleName":"","lastName":"Cui","suffix":""},{"id":631853501,"identity":"033c0858-2ba3-4ade-8a58-25befd97859f","order_by":2,"name":"Li Zhao","email":"","orcid":"","institution":"Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhao","suffix":""},{"id":631853504,"identity":"fcc86894-8e63-4858-8e9a-10db46cd0e47","order_by":3,"name":"Zhiqiang Feng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYBAC+xmMDQwJIJb8AyBRwQDkgsAB3FoY4VokQMQZorTAWCAtjG1EaGGWbm688aDmjl2DBPOxh1/n2cg2sB9+wMxzBrcWNpmDzRYJx54lN8i3pRvLbkszbuBJM2DmuYFbC49EYptEAtvhZAYJHjNpyW2HExsYchiYeT7g1iIB1vIPpIX/m7TknP+JDfxv8GsxAGlJbDtsB7SFTfJjw4HEBgmQLXgcBtTSbJHYdziBTYLNTJrhWLJxm8Qzg4Nz8Hjffkb6w5s/vh2255dgfib5o8ZOtp8/+eGDN8dwawH7B4gT24AEMw+QYGPAGysILfYgBuMPQkpHwSgYBaNgRAIAjS5RdEEmIJEAAAAASUVORK5CYII=","orcid":"","institution":"University of Edinburgh","correspondingAuthor":true,"prefix":"","firstName":"Zhiqiang","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2026-03-16 09:39:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9135913/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9135913/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108244817,"identity":"d79c6e6c-a772-4689-9edf-544888dbbe55","added_by":"auto","created_at":"2026-04-30 23:02:45","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":712775,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptrevisedwithcity.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9135913/v1_covered_31a0ccaf-4d80-4a9d-ac78-4afdcd804a21.pdf"},{"id":108244816,"identity":"cca1c5fb-007c-4d33-b8bc-e2f90e46651c","added_by":"auto","created_at":"2026-04-30 23:02:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":529415,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-9135913/v1/249c41539a6e1d1d716cb688.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Structure Widowhood Effect on Medical Utilization: Bereaved or Unprotected","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Widowhood effect, Medical care utilization, Bereaved effect, Marriage protection, Health behavior","lastPublishedDoi":"10.21203/rs.3.rs-9135913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9135913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFamily health behaviors are increasingly recognized as critical determinants of healthcare utilization. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that inpatient care usage significantly increases after spousal loss, while outpatient care remains stable. To explain this divergence, we examine health status and chronic disease management among the widowed, finding they experienced poorer health outcomes and reduced access to routine care. Lacking spousal support and monitoring, widowed individuals often fail to adhere to medications, even if diagnosed, leading to preventable disease progression and hospitalization. Our findings highlight that, in addition to the well-documented bereaved effect, the unprotected effect \u0026ndash;loss of marriage\u0026rsquo;s protective health behaviors \u0026ndash; is also a crucial determinant of increased medical utilization following widowhood. 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