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Hu Y, Wang Z, Wu L. Multidimensional health heterogeneity of Chinese older adults and its determinants. SSM Popul Health 2023; 24:101547. [PMID: 38021459 PMCID: PMC10661850 DOI: 10.1016/j.ssmph.2023.101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Nowadays, the "Healthy China" and "Actively Addressing Population Aging" are two important national strategies in China. Promoting high-quality development of demand-driven older adults health services is an important way to achieve these strategies. From the perspective of active ageing, assessing the health status of older adults from multiple dimensions becomes crucial as it helps identify their specific health service needs, intervention measures, and health policies tailored to this population. Methods Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 (2018). A total of 4190 older adults (aged ≥60 years) were included as the analysis sample. Latent class analysis was performed to categorize older adults based on 6 health indicators, including Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), doctor diagnosed chronic diseases, depressive symptoms, cognitive function, and social participation. Multinomial logistic model was used to explore determinants associated with the various patterns of multidimensional health of older adults. Results The multidimensional health of older people was classified into three latent classes: Relatively Healthy (Class 1, n = 2806, 66.97%), Highly Depressed and Relatively Health Risk (Class 2, n = 1189, 28.38%), and Functional Impairment (Class 3, n = 195, 4.65%). Gender, age, education, marital status, number of children, alcohol consumption, physical activity, savings, residence, air quality satisfaction, and medical service satisfaction had significant effects on the attribution of all multidimensional health latent classes. Conclusion Heterogeneous and multidimensional health classes exist in China's older population, and these classes are influenced by a variety of factors and to varying degrees. Policymakers and healthcare providers can use these evidence to further address the diverse needs of older adults and improve older-care health services, ultimately achieving the goal of Active Ageing and Healthy China.
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Affiliation(s)
- Yi Hu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, 518028, China
| | - Zhenyu Wang
- School of Government, Sun Yat-sen University, Guangzhou, Guangdong, 510006, China
| | - Liqun Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, 518028, China
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Li Q, Liu Y, Yang L, Ge J, Chang X, Zhang X. The impact of urban green space on the health of middle-aged and older adults. Front Public Health 2023; 11:1244477. [PMID: 37900020 PMCID: PMC10602898 DOI: 10.3389/fpubh.2023.1244477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Urban green space is one of the most closely related ecosystem services to residents' lives, and it can be regarded as a preventive public health measure. Residents living in parks and other green environments can help improve their physical and mental health, reduce stress and even prevent crime and violence. Therefore, based on the actual situation in China, this paper analyzes the relationship between urban green space and the health of middle-aged and older adults and its mechanisms. Methods This study used multiple linear regression, based the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018, to explore the relationship between urban green space and the health of middle-aged and older adults. At the same time, group regression was conducted to identify the heterogeneity of health effects of urban green space. Results The research shows that the increase of urban green space areas can significantly improve the health status of middle-aged and older adults. After a series of robustness tests, the results are still valid. In addition, the health effects of urban green space are different because of gender, age, education level, marital status residence, geographical location of the respondents and park quantity distribution. Further research found that reducing hot weather and optimizing air quality are the potential mechanisms of urban green space affecting the health of middle-aged and older adults, providing new evidence for the causal mechanism between urban green space and the health of middle-aged and older adults. Discussion This study expanded the research scope of the impact of urban green space on the health of middle-aged and older adults, covering a representative sample in China. The results show that urban green space has an important impact on the health of middle-aged and older adults. Policy suggestions are made to help cities optimize the landscape and residents to enjoy ecology.
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Affiliation(s)
- Qiangyi Li
- School of Economics and Management, Guangxi Normal University, Guilin, China
- Development Institute of Zhujiang-Xijiang Economic Zone, Guangxi Normal University, Guilin, China
- Economics and Management School, Wuhan University, Wuhan, China
| | - Yangqing Liu
- School of Economics and Management, Guangxi Normal University, Guilin, China
| | - Lan Yang
- School of Economics and Management, Guangxi Normal University, Guilin, China
| | - Jiexiao Ge
- School of Economics and Management, Guangxi Normal University, Guilin, China
| | - Xiaona Chang
- School of Economics and Management, Guangxi Normal University, Guilin, China
| | - Xiaohui Zhang
- School of Economics and Management, Guangxi Normal University, Guilin, China
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Wu N, Xie X, Cai M, Han Y, Wu S. Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey. Int J Equity Health 2023; 22:169. [PMID: 37649033 PMCID: PMC10466757 DOI: 10.1186/s12939-023-01983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Aging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults' needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens. METHODS The research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993-2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements. RESULTS The two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70-79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%). CONCLUSION The elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.
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Affiliation(s)
- Nina Wu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Xueqin Xie
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Min Cai
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Shiyong Wu
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China.
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Liu TY, Qiu DC, Chen T. Effects of Social Participation by Middle-Aged and Elderly Residents on the Utilization of Medical Services: Evidence From China. Front Public Health 2022; 10:824514. [PMID: 35875043 PMCID: PMC9301239 DOI: 10.3389/fpubh.2022.824514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAim to evaluate the effect of social participation on utilization of medical services among middle-aged and elderly residents in China.MethodsWe used data from the 2018 wave of the China Health and Retirement Longitudinal Study. Social participation is classified into three types. Furthermore, to control for confounding factors, our study computed propensity score matching (PSM) to evaluate the effect of social participation on the utilization of medical services.ResultThe result of PSM indicates that social participation significantly positively affects the utilization of outpatient services, the average treatment effect on the treated (ATT = 0.038***) and the utilization of inpatient services (ATT = 0.015**) by middle-aged and elderly residents. Furthermore, the utilization of outpatient health care services was significantly positively associated with leisure activities (ATT = 0.035***), social activities to help others (ATT = 0.031***), and learning activities to gain new knowledge (ATT = 0.034***) among middle-aged and elderly residents. The utilization of inpatient health care was significantly positively associated with leisure activities (ATT = 0.015***) but had no significant association with social deeds that help others and increased new knowledge among middle-aged and elderly residents.ConclusionThus, social participation significantly positively affects healthcare utilization by middle-aged and elderly residents. Hence, the government and society should provide more conveniences and promote social participation among middle-aged and elderly residents.
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Affiliation(s)
- Tai-Yi Liu
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - De-Chao Qiu
- Jintang First People's Hospital, West China Hospital Sichuan University, Jingtang, China
| | - Ting Chen
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Ting Chen
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Yuan B, Li J, Liang W, Lan J. Late career participation of late retirees in the age of the silver tsunami: understanding the influencing mechanism of health status and employment-based health insurance participation. Health Res Policy Syst 2022; 20:53. [PMID: 35525956 PMCID: PMC9077966 DOI: 10.1186/s12961-022-00853-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background The delayed retirement initiative and population aging have led to a growing group of late retirees. However, it remains unclear whether the existing employment-based health insurance system can effectively match the recently proposed initiative and support late retirees, especially those with pre-existing function limitations. Thus, this study aims to investigate the influencing mechanism of China’s Urban Employee Basic Medical Insurance (UEBMI), physical functioning limitation (PFL) and difficulty in instrumental activities of daily living (IADLs) on labour participation of late retirees in China. Methods This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) survey, which tracks the quality of life among older adults in China (valid sample size = 5560). Results Empirical results show that China’s employment-based health insurance (i.e. UEBMI) and health conditions (i.e. PFL and difficulty in IADLs) are positively associated with late retirees’ withdrawal from late career participation. In addition, a higher level of difficulty in IADLs could strengthen the effect of PFL on late retirees’ withdrawal from late career participation, which could be further buffered by UEBMI beneficiary status. Conclusion In the formulation of delayed retirement policies, it is necessary to consider the influencing mechanism of the social health insurance system and health conditions on late career participation of older workers to ensure policy effectiveness.
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Affiliation(s)
- Bocong Yuan
- School of Tourism Management, Sun Yat-sen University, West Xingang Rd.135, Guangzhou, 510275, China
| | - Jiannan Li
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, 519087, China.
| | - Wenqi Liang
- School of Tourism Management, Sun Yat-sen University, West Xingang Rd.135, Guangzhou, 510275, China
| | - Junbang Lan
- School of Tourism Management, Sun Yat-sen University, West Xingang Rd.135, Guangzhou, 510275, China.
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Wang N, Gao W, Ma M, Shan L, Fu X, Sun T, Xia Q, Tian W, Liu L, Yang H, Shi B, Li H, Ma Y, Jiao M, Wu Q, You D, Li Y. The medical insurance system's weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study. Arch Gerontol Geriatr 2020; 92:104227. [PMID: 32979552 DOI: 10.1016/j.archger.2020.104227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. METHODS Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. RESULTS The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. CONCLUSIONS The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.
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Affiliation(s)
- Nianshi Wang
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Wei Gao
- Heilongjiang Provincial Hospital, Department of Infectious Diseases, No. 82, Zhongshan Road, Xiangfang District, Harbin, Heilongjiang, 150000, China
| | - Meiyan Ma
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Linghan Shan
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Xuelian Fu
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Tao Sun
- Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Zhejiang, China
| | - Qi Xia
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Wanxin Tian
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Limin Liu
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Huiying Yang
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Heng Li
- Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Ma
- China Medical University, Liaoning, China
| | - Mingli Jiao
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
| | - Qunhong Wu
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
| | - Dingyun You
- School of Public Health, Kunming Medical University, Kunming, Yunnan, 650500, China.
| | - Ye Li
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
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Ma M, Li Y, Wang N, Wu Q, Shan L, Jiao M, Fu X, Li H, Sun T, Yi B, Tian W, Xia Q, Shi B, Hao Y, Yin H, Ning N, Gao L, Liang L, Wang J. Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China? Characteristics of vulnerable groups and failure links. BMC Public Health 2020; 20:435. [PMID: 32245435 PMCID: PMC7118817 DOI: 10.1186/s12889-020-08554-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. METHODS A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. RESULTS The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. CONCLUSIONS The original poverty-promoting policies has not reached the maximum point of convergence with China's current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.
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Affiliation(s)
- Meiyan Ma
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ye Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| | - Nianshi Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Xuelian Fu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Heng Li
- China Hospital Development institute of Shanghai Jiao Tong University, Shanghai, China
| | - Tao Sun
- Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Zhejiang, China
| | - Bin Yi
- The First Specialized Hospital of Harbin, Harbin, Heilongjiang, China
| | - Wanxin Tian
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Hui Yin
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Jiahui Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
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