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The Current Landscape of Congenital Heart Surgery in Northern China: A Geographic and Population-Based Analysis
Zhanhao Su1, Li Xiang1, Zeye Liu1
1State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Many congenital heart surgery facilities in northern China lack specialists, leading to suboptimal care for children with congenital heart disease. Significant geographic disparities exist, requiring policy attention to improve access to high-quality surgical services.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Pediatric Cardiology
Background:
- Congenital heart disease (CHD) is a leading birth defect in China, necessitating congenital heart surgery (CHS) for many patients.
- The availability and accessibility of specialized CHS resources in China remain largely uncharacterized.
- Understanding the current distribution of CHS facilities and their specialist capacity is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the landscape of CHS facilities in northern China.
- To assess the specialist capacity and geographic accessibility of these facilities.
- To identify disparities in access to high-quality CHS for pediatric patients.
Main Methods:
- Identification of CHS-performing facilities from a 2018 Chinese cardiovascular surgery white book.
- Categorization of facilities into full or limited specialist capacity.
- Utilization of census and road data for service area analysis to estimate geographic accessibility.
Main Results:
- Only 30.1% of 93 surveyed facilities in northern China possessed full specialist capacity, primarily limited by pediatric cardiologists and mechanical support.
- A significant proportion of CHS cases (31.6%) were performed in lower-volume, limited-capacity facilities.
- Geographic accessibility is poor, with only 12.9% of children under 5 in northern China living within 30 km of a facility, and a majority needing to travel over 180 km for care at full-capacity centers.
Conclusions:
- Limited specialist capacity and significant geographic disparities in northern China compromise access to high-quality congenital heart surgery.
- Many patients with congenital heart disease receive suboptimal surgical care due to these limitations.
- Policy interventions are urgently needed to address geographic inequities and ensure disadvantaged patients can access specialized CHS.
Abstract:
Background: Congenital heart disease (CHD) is the leading birth defect in China, and many patients require congenital heart surgery (CHS) to achieve optimal outcomes. However, the current landscape and population accessibility to specialist resources for CHS in China are unclear. Methods: Care facilities performing CHS were identified from the 2018 white book of Chinese cardiovascular surgery and were categorized as full or limited facilities based on specialist capacity. Census-based population data and road data were obtained from administrative sources. Service area analysis of all facilities was performed to estimate geographic accessibility. Results: Of 93 facilities in 14 provinces and municipalities in northern China, only 30.1% had full specialist capacity. The shortage of pediatric cardiologists and mechanical circulatory support was the primary limiting factor. In 2018, 61.3% of facilities performed <200 CHS cases, and 31.6% of all CHS cases (N = 30,921) were performed in limited facilities with substantially lower volume than full-capacity facilities (median value: 85.0 vs. 368.0). Beijing had a disproportionately higher CHS volume (367 cases per million population) than other provinces. Of all children under 5 in northern China, only 12.9% live within 30 km (a typical half-day visit) of the service areas of all facilities. Compared to children from the eastern region (31.4%), 71.8% of children from the central region and 70.2% of children from the western region needed to travel >180 km (a typical overnight visit) to receive care in full-capacity facilities. Conclusions: Many facilities for CHS in northern China had limited specialist capacity, and many CHD patients received suboptimal surgical care. Policy measures should address the significant geographic disparities to receive high-quality surgical care among disadvantaged patients.
