Hanmo Yang

All Publications

• Universal health coverage in China part 1: progress and gaps. The Lancet. Public health Yip, W., Fu, H., Jian, W., Liu, J., Pan, J., Xu, D., Yang, H., Zhai, T. 2023; 8 (12): e1025-e1034

  Abstract

  Over the past 2 decades, China has made remarkable progress in health-care service coverage, especially in the areas of reproductive, maternal, newborn, and child health, infectious diseases, and service capacity and access. In these areas, coverage is comparable to those in high-income countries. Inequalities of service coverage in these areas have been reduced. However, there remain large gaps in the service coverage of chronic diseases. There has been little progress in controlling risk factors of chronic diseases in the past 10 years. Service coverage for most chronic conditions is lower than in high-income countries. Moreover, China has disproportionately high incidences of catastrophic health expenditure compared with countries with similar economic development. This paper comprehensively evaluates China's progress towards universal health coverage by identifying the achievements and gaps in service coverage and financial risk protection that are crucial to achieve universal health coverage goals by 2030.

  View details for DOI 10.1016/S2468-2667(23)00254-2

  View details for PubMedID 38000882

• Universal health coverage in China part 2: addressing challenges and recommendations. The Lancet. Public health Yip, W., Fu, H., Jian, W., Liu, J., Pan, J., Xu, D., Yang, H., Zhai, T. 2023; 8 (12): e1035-e1042

  Abstract

  This report analyses the underlying causes of China's achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China's ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Here, we used a health system conceptual framework and we propose a set of feasible policy recommendations that draw from international experiences and first-hand knowledge of China's unique institutional landscape. Our six recommendations are: instituting a primary care-focused integrated delivery system that restructures provider incentives and accountability mechanisms to prioritise prevention; leveraging digital tools to support health behaviour change; modernising information campaigns; improving financial protection through insurance reforms; promoting a health in all policy; and developing a domestic monitoring framework with refined tracer indicators that reflects China's disease burden.

  View details for DOI 10.1016/S2468-2667(23)00255-4

  View details for PubMedID 38000883

• Estimating causal effects of physical disability and number of comorbid chronic diseases on risk of depressive symptoms in an elderly Chinese population: a machine learning analysis of cross-sectional baseline data from the China longitudinal ageing social survey. BMJ open Wang, Z., Yang, H., Sun, C., Hong, S. 2023; 13 (7): e069298

  Abstract

  This study aimed to explore the causal effects of physical disability and number of comorbid chronic diseases on depressive symptoms in an elderly Chinese population.Cross-sectional, baseline data were obtained from the China Longitudinal Ageing Social Survey, a stratified, multistage, probabilistic sampling survey conducted in 2014 that covers 28 of 31 provincial areas in China. The causal effects of physical disability and number of comorbid chronic diseases on depressive symptoms were analysed using the conditional average treatment effect method of machine learning. The causal effects model's adjustment was made for age, gender, residence, marital status, educational level, ethnicity, wealth quantile and other factors.Assessment of the causal effects of physical disability and number of comorbid chronic diseases on depressive symptoms.7496 subjects who were 60 years of age or older and who answered the questions on depressive symptoms and other independent variables of interest in a survey conducted in 2014 were included in this study.Physical disability and number of comorbid chronic diseases had causal effects on depressive symptoms. Among the subjects who had one or more functional limitations, the probability of depressive symptoms increased by 22% (95% CI 19% to 24%). For the subjects who had one chronic disease and those who had two or more chronic diseases, the possibility of depressive symptoms increased by 13% (95% CI 10% to 15%) and 20% (95% CI 18% to 22%), respectively.This study provides evidence that the presence of one or more functional limitations affects the occurrence of depressive symptoms among elderly people. The findings of our study are of value in developing programmes that are designed to identify elderly individuals who have physical disabilities or comorbid chronic diseases to provide early intervention.

  View details for DOI 10.1136/bmjopen-2022-069298

  View details for PubMedID 37407052

  View details for PubMedCentralID PMC10335586

• Third-child fertility intention and its socioeconomic factors among women aged 20-34 years in China. BMC public health Yang, H., Han, R., Wang, Z. 2023; 23 (1): 821

  Abstract

  The low birth rates and rapid population aging has drawn considerable attention from scholars and policymakers in China and around the world. In 2021, China launched the policy and supportive measures that allow up to 3 children per couple. This study aims to explore the influencing factors of the third-child fertility intention among women aged 20-34 years in China.We draw data from the National Fertility Survey conducted in 2017. The nationally representative survey adopts a stratified, 3-stage, and probabilities proportional to size sampling method. A total of 61,588 valid samples aged 20-34 years old were obtained. Fertility desire and behavior, childbearing and service use, and potential influencing factors of fertility intention such as the history of pregnancy were assessed.In general, 5.01% of Chinese women of prime childbearing age had fertility intention for a third child, and the proportion varies by region across mainland China. Individual characteristics such as being ethnic minorities, being rural residents, and having more siblings are significantly positively correlated with the third-child fertility intention, while the intention was significantly lower among women with a higher income or education level, migrant women, and those engaged in the non-agricultural labor force. Women who already had a son had lower fertility intention for a third child. Moreover, it was the perceived acceptable costs of childcare services rather than the actual costs that mattered more for the fertility intention.Our study concludes a series of socioeconomic factors, and previous childbearing and childrearing experiences are crucial for women's fertility intention for a third child. These findings highlight the importance of launching supportive measures in addition to the introduction of the 3-child policy in promoting a fertility-friendly society.

  View details for DOI 10.1186/s12889-023-15719-3

  View details for PubMedID 37143051

  View details for PubMedCentralID PMC10161537

• Association of empty nest with depressive symptom among Chinese elderly population: The China Longitudinal Aging Social Survey. Medicine Zheng, P., Yang, H., Wang, Z. 2022; 101 (26): e29841

  Abstract

  Currently, empty nest has become one type of the family pattern among the old population and it influences the old population's mental health. The current study aimed to explore the association between the empty nest and depressive symptoms (DSs) among the elderly population in China. Data were obtained from baseline of the China Longitudinal Aging Social Survey. Logistic regression was used to examine the association between the empty nest and DS among Chinese older adults. In the current study, 48% of the subjects were empty-nest elderly. The prevalence of DS was 43.7% among the empty-nest old population, which was higher than the nonempty nesters. A positive association was found between the empty nest and DS; the odds ratio (95% confidence interval) was 1.28 (1.16-1.42). No matter living with a spouse or living alone, empty nesters were more likely to have DS than nonempty nesters. Empty nest is a risk factor for having DS among the old population in China, especially among those who live without a spouse. Our result is valuable for the development of special family support DS prevention programs for those who were empty nest.

  View details for DOI 10.1097/MD.0000000000029841

  View details for PubMedID 35777037

  View details for PubMedCentralID PMC9239606

• Socioeconomics, health-related factors, and tooth loss among the population aged over 80 years in China. BMC public health Yang, H., Han, R., Wang, Z. 2022; 22 (1): 444

  Abstract

  The prevalence of tooth loss varies across the globe among oldest-old individuals. The presence of fewer than 20 teeth in old age was associated with a decrease in people's health and quality of life. This paper explored the association between socioeconomics, health-related factors, and tooth loss among the population over the age of 80 in China.The tooth loss status of older Chinese adults was collected with a structured questionnaire from the 8th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 6716 individuals aged 80 years and above were included. Logistic regression was used to assess the association between socioeconomic statuses, dietary intake at approximately 60 years old, health-related factors, and tooth loss.Of the 6716 individuals aged 80 years and above, the composition of the group with fewer teeth for both men and women was statistically significant in many ways. Multivariate logistic regression analyses show that for men, being older than 90 years and being ADL disabled (adjusted OR: 1.71, 95% CI: 1.01-2.89) are factors that are significantly and consistently associated with a higher risk of having fewer than 20 teeth, while having a higher household income per capita (adjusted OR: 0.56, 95% CI: 0.32-0.99) decreases the risk. For women, an age of above 95 years, brushing teeth less than once per day (adjusted OR: 1.96, 95% CI: 1.26-3.03), consuming sugar some of the time as opposed to less than once per month at approximately 60 years old (adjusted OR = 1.74, 95% CI: 1.15-2.62), and being ADL disabled (adjusted OR: 1.70, 95% CI: 1.04-2.77) are factors that are significantly associated with the risk of having fewer than 20 teeth.The analysis suggests that socioeconomic status, dietary intake in early old age, and ADL capacity are associated with the risk of having fewer teeth for the population aged 80 years and above, and the risk factors vary between sexes.

  View details for DOI 10.1186/s12889-022-12861-2

  View details for PubMedID 35247999

  View details for PubMedCentralID PMC8898425

• Impacts of family household dynamics on residential energy demands in Hebei Province of China GENUS Zeng, Y., Yang, H., Wang, Z., Li, L. 2021; 77 (1)

  View details for DOI 10.1186/s41118-021-00148-0

  View details for Web of Science ID 000730918100002

• Does Ownership Matter for Medical System Performance? Evidence From a Natural Experiment in Suqian, China. Inquiry : a journal of medical care organization, provision and financing Liu, G. G., Shi, J., Wang, X., Yang, H., Zhu, H. 2020; 57: 46958020944338

  Abstract

  There has long been a major policy debate on the role of hospital ownership (private vs public) in medical system performance. China's health care delivery system is mainly a public system. In 2000, a full privatization reform was implemented in the city of Suqian, offering a unique opportunity to assess possible effects of private delivery based on a major external shock to the existing system. Compared with all other cities in Jiangsu province since 2003, Suqian did not experience any greater increase either in total outpatient or inpatient expenditures. In the meantime, Suqian performed equally well as other cities in terms of changes in number of inpatient admissions and average inpatient days, and even better for mortality rate in emergency rooms. This study concludes that under appropriate public financing, private delivery can serve the public demand at least equally well as public providers in terms of cost inflations and utilizations.

  View details for DOI 10.1177/0046958020944338

  View details for PubMedID 32705918

  View details for PubMedCentralID PMC7383729

• Life negative events and depressive symptoms: the China longitudinal ageing social survey. BMC public health Wang, Z., Yang, H., Zheng, P., Liu, B., Guo, Z., Geng, S., Hong, S. 2020; 20 (1): 968

  Abstract

  Although some studies have reported the association between life negative events and depressive disorders, very limited studies have examined the association between life negative events exposure and depressive symptoms risk among Chinese older adults.Data were obtained from the China Longitudinal Ageing Social Survey (CLASS), which was a stratified, multi-stage, probabilistic sampling survey, conducted in 2014. General linear regression and logistic regression were used to examine the association between life negative events exposure and depressive symptoms among Chinese older adults.Life negative events showed statistical dose-response association with depressive symptoms risk after adjustment for the confounding factors (Ptrend < 0.001). Under consideration of life negative events exposure, participants who lived in rural areas, without a spouse or live alone were vulnerable to depressive symptoms.Life negative events played a risk role of depressive symptoms among Chinese older adults, especially among those in rural areas, females or without a spouse. Our current study is valuable for the development of special prevention depressive symptoms programs among elderly individuals, especially those who have experienced negative events.

  View details for DOI 10.1186/s12889-020-09119-0

  View details for PubMedID 32560710

  View details for PubMedCentralID PMC7305594

• Socio-demographic characteristics and co-occurrence of depressive symptoms with chronic diseases among older adults in China: the China longitudinal ageing social survey. BMC psychiatry Wang, Z., Yang, H., Guo, Z., Liu, B., Geng, S. 2019; 19 (1): 310

  Abstract

  The aim of the current study is to assess the cross-sectional association of chronic non-communicable diseases (hypertension, diabetes mellitus, arthritis, and cerebrovascular) with depressive symptoms among older adults in China.Data was obtained from the China Longitudinal Ageing Social Survey (CLASS) conducted in 2014. A total of 7505 participants were included. Depressive symptoms status was assessed by 9-item Center for Epidemiological Studies Depression Scale (CES-D) Associations between depressive symptoms and chronic diseases, adjusting for so, demographics and chronic diseases risk factors were assessed by using logistic regression model.We found negative associations between depressive symptoms and several socioeconomic factors, including education attainment and economic level. Widowed/divorced/ unmarried individuals are more likely to suffer from depressive symptoms. Hypertension (Odds ratio:1.29 [95%CI:1.16, 1.42]), diabetes (1.41 [95%CI:1.19,1.67]), arthritis (1.72 [1.52, 1.96]), and cerebrovascular disease (1.69 [1.41, 2.02]) were found to be associated with depressive symptoms.Most depressive symptoms cases were found to be significantly associated with chronic diseases. Our findings have provided evidence for understanding co-morbid depressive symptoms with chronic diseases, which could help clinicians to evaluate, diagnose and manage depression promptly.

  View details for DOI 10.1186/s12888-019-2305-2

  View details for PubMedID 31646992

  View details for PubMedCentralID PMC6813124