Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in
Xi Zhang1,2, Jian Wang1, Li-Su Huang1,3
1Department of Pediatrics, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Low pediatrician numbers correlate with higher under-five mortality risks. Both the number of pediatricians per child and their geographical distribution are crucial for child healthcare planning.
Area of Science:
- Pediatric Health
- Public Health Policy
- Healthcare Resource Allocation
Background:
- Under-five mortality rate (U5MR) is a key indicator of child health.
- Understanding the impact of pediatric workforce distribution on U5MR is essential for effective healthcare planning.
Purpose of the Study:
- To investigate the association between pediatric human resources and under-five mortality.
- To analyze the influence of pediatricians per thousand children (PPTC) and geographical distribution on U5MR.
Main Methods:
- Analysis of national survey data from 2015-2016 across 31 mainland Chinese provinces.
- Logistic regression and restricted cubic spline models were used to assess associations between pediatric workforce measures and high U5MR risk.
- Confounders were adjusted for in the statistical models.
Main Results:
- Counties with the lowest PPTC (<0.2) showed a 52% higher risk of high U5MR compared to those with the highest PPTC (≥0.7).
- An inverted J-shaped relationship was observed between pediatrician density per 10,000 km² and high U5MR risk.
- Geographical pediatrician density demonstrated a stronger association with high U5MR risk than PPTC.
Conclusions:
- Both population-based and geographical pediatrician density are critical factors in planning child healthcare services.
- Healthcare planning must consider pediatrician distribution, even in regions with adequate PPTC.
Background:
To quantify the associations between the under-five mortality rate (U5MR) and measures of pediatric human resources, including pediatricians per thousand children (PPTC) and the geographical distribution of pediatricians.
Methods:
We analyzed data from a national survey in 2015-2016 in 2636 counties, accounting for 31 mainland provinces of China. We evaluated the associations between measures of pediatric human resources and the risk of a high U5MR (≥ 18 deaths per 1000 live births) using logistic regression and restricted cubic spline regression models with adjustments for potential confounders. PPTC and pediatricians per 10,000 km2 were categorized into quartiles. The highest quartiles were used as reference.
Results:
The median values of PPTC and pediatricians per 10,000 km2 were 0.35 (0.20-0.70) and 150 (50-500), respectively. Compared to the counties with the highest PPTC (≥ 0.7), those with the lowest PPTC (< 0.2) had a 52% higher risk of a high U5MR, with an L-shaped relationship. An inverted J-shaped relationship was found that the risk of a high U5MR was 3.74 [95% confidence interval (CI) 2.55-5.48], 3.07 (95% CI 2.11-4.47), and 2.25 times (95% CI 1.52-3.31) higher in counties with < 50, 50-149, and 150-499 pediatricians per 10,000 km2, respectively, than in counties with ≥ 500 physicians per 10,000 km2. The joint association analyses show a stronger association with the risk of a high U5MR in geographical pediatrician density than PPTC.
Conclusion:
Both population and geographical pediatrician density should be considered when planning child health care services, even in areas with high numbers of PPTC.
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