When widowhood meets hospitalisation risk: the dynamic, time-dependent association in older adults

@article{li2026when,
  title = {{When widowhood meets hospitalisation risk: the dynamic, time-dependent association in older adults}},
  author = {Jiaxue Li and Jiabao Yan and Jun Li and Junqiang Feng and Changsheng Chen and Qiuxiang Yuan and Yaxin Liu and Xiaoyu Li and Liang Zhu},
  journal = {BMC Geriatrics},
  year = {2026},
  month = jul,
  doi = {10.1186/s12877-026-07966-x},
  url = {https://doi.org/10.1186/s12877-026-07966-x},
  note = {CC BY},
}

TY  - JOUR
TI  - When widowhood meets hospitalisation risk: the dynamic, time-dependent association in older adults
AU  - Jiaxue Li
AU  - Jiabao Yan
AU  - Jun Li
AU  - Junqiang Feng
AU  - Changsheng Chen
AU  - Qiuxiang Yuan
AU  - Yaxin Liu
AU  - Xiaoyu Li
AU  - Liang Zhu
PY  - 2026
DA  - 2026/07/01
JO  - BMC Geriatrics
DO  - 10.1186/s12877-026-07966-x
UR  - https://doi.org/10.1186/s12877-026-07966-x
AB  - Background In China’s rapidly ageing society, widowhood is a prevalent stressor, yet the temporal dynamics of its impact on healthcare utilisation remain poorly understood. While “widowhood shock” is documented in Western settings, how the association evolves with duration in China’s distinct sociocultural context is unknown. Objectives This study aimed to investigate the heterogeneous and dynamic association between widowhood and hospitalization risk among Chinese older adults, and to verify the robustness of the findings through rigorous causal identification methods. Methods Using five waves of longitudinal data (2011–2020) from the China Health and Retirement Longitudinal Study (CHARLS), including a total of 9,428 participants aged ≥ 60 years (942 widowed and 8,486 non-widowed). We adopted the heterogeneous difference-in-differences (CSDID) approach combined with doubly robust inverse probability weighted regression adjustment (DRIPW) to estimate cohort-specific average treatment effects on the treated (ATT). Propensity score matching was used to balance 16 covariates across sociodemographic, health, social support, economic, and insurance domains. Gender-stratified analyses were conducted as a robustness check to explore potential disparities. Results After achieving covariate balance (standardized bias reduction > 70% for all key variables), widowhood significantly increased hospitalization risk among Chinese older adults aged ≥ 60 years, with an overall ATT of 0.051 (SE = 0.019, P = 0.007). Heterogeneity was observed across cohorts and calendar time: Cohort G3 (first widowed in 2015) had the strongest effect (ATT = 0.061, P = 0.024), while Cohorts G2 (2013) and G5 (2020) showed no significant positive effects; calendar-time effects were significant in T3 (2015, ATT = 0.073, P = 0.009) and T5 (2020, ATT = 0.054, P = 0.039) but not in T2 (2013) and T4 (2018), reflecting differences between cohort-specific treatment effects and overall temporal trends. Dynamic analysis showed a significant immediate effect in the year of widowhood (period 0: ATT = 0.060, SE = 0.021, P = 0.004). This effect attenuated and became statistically non-significant in the subsequent 1–3 waves, indicating an immediate but non-persistent “shock” pattern. Robustness checks confirmed the reliability of the core findings. Conclusions Widowhood exerts a significant positive impact on hospitalization risk among Chinese older adults, with heterogeneous effects across cohorts and calendar time and an immediate but non-persistent dynamic pattern. These findings highlight the need for targeted interventions, particularly during the immediate year following spousal loss and for specific high-risk cohorts. Practical steps include enhancing family-based health management support and optimizing healthcare accessibility for rural widowed older adults.
SN  - 1471-2318
ER  -