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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>China\u2019s rapid population aging and shrinking family structures challenge healthcare access for older adults, especially those living alone. While the link between solitary living and poor health is well-documented, its underlying mechanisms remain unclear. This study examines how living alone shapes healthcare-seeking preferences and behaviors to elucidate its pathways to health in later life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using longitudinal data from the China Family Panel Studies (2010\u20132020), restricted to a sample of adults aged 60 and above, we employed a linear probability model with individual and time fixed effects to examine the impact of living alone on two key outcomes: the probability of consulting a doctor when ill (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093,911) and the preference for primary healthcare centers (PHCs) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911,956). The model controlled for a set of covariates including demographic characteristics, family attributes, and health status measures. Heterogeneity analyses were conducted by gender,\n                      <jats:italic>hukou<\/jats:italic>\n                      status, and household income.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Living alone was associated with a significant reduction in the probability of consulting a doctor (20.2% points), with the effect more pronounced among older women, suggesting that emotional or psychological barriers may exacerbate their vulnerability. In contrast, older adults living alone demonstrated a stronger preference for PHCs (10.9% points), a tendency that was particularly evident among lower-income and urban residents, likely due to the greater accessibility, lower cost, and shorter waiting times of PHCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Strengthening community-based interventions and enhancing the quality and coverage of primary care\u2014particularly in rural areas\u2014are essential to reducing treatment delays and promoting early care-seeking. Policy efforts should prioritise the unique vulnerabilities of older women, low-income individuals, and rural residents by addressing emotional barriers, improving health literacy, and enhancing the accessibility of services. Rebuilding trust in primary care requires sustained investment in provider professionalism, facility infrastructure, and efficient referral systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-025-03164-7","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T07:53:57Z","timestamp":1767772437000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does living alone reshape healthcare use? 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The CFPS data used in this research are publicly available at\n                      \n                      . All participants or their proxy respondents provided written informed consent after being fully informed of the study content and potential outcomes.The Biomedical Ethics Review Committee of Peking University approved the CFPS study in accordance with a comprehensive framework of relevant laws, administrative regulations, departmental rules, normative documents, and international ethical guidelines. These include the Civil Code of the People\u2019s Republic of China, the Law on Physicians, the Regulations on the Administration of Medical Institutions, the Basic Healthcare and Health Promotion Law, the Personal Information Protection Law, the Drug Administration Law, the Data Security Law, the Regulations on the Administration of Human Genetic Resources, the Good Clinical Practice for Drug Trials, the Measures for the Ethical Review of Biomedical Research Involving Humans, the Guidelines for Ethical Review of Drug Clinical Trials, and the Administrative Measures for Investigator-Initiated Clinical Research in Medical and Health Institutions (Trial).The review also adhered to international ethical principles and standards, including the Declaration of Helsinki (World Medical Association), the Operational Guidelines for Ethics Committees Reviewing Biomedical Research (World Health Organization), and the International Ethical Guidelines for Health-related Research Involving Humans (Council for International Organizations of Medical Sciences, CIOMS). Additionally, the approval was granted in accordance with the subject protection policies of Peking University. Based on this comprehensive ethical and regulatory framework, the committee agreed to the conduct of the CFPS study in line with the approved research protocol. Consent for publication is not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"38"}}