Analysis of under-five mortality rate and healthcare utilization equity in Hunan Province, China, 2020-2024

To analyze under-five mortality trends, causes of death, and urban-rural/gender disparities in Hunan Province, China (2020-2024) and to evaluate healthcare equity.

Under-five death data (n = 8875) from the provincial reporting system were linked to live-birth records. Mortality rates for early neonates, neonates, infants, and children under five were calculated. Descriptive analysis and chi- square tests were used.

The under-five mortality rate (U5MR) declined significantly from 4.92‰ in 2020 to 3.29‰ in 2024 (P < 0.05 for trend). Mortality was significantly higher in rural than urban areas across all age groups: U5MR was 5.88‰ vs. 1.86‰ (rural ≈ 3.2 times higher, P < 0.01); infant mortality was 3.42‰ vs. 1.21‰ (P < 0.01). Boys had higher mortality than girls (under-five: 4.53‰ vs. 3.68‰, P < 0.01). Preterm birth/birth asphyxia dominated early deaths; accidental asphyxia and drowning prevailed in later childhood, especially in rural areas. The proportion of untreated deaths increased with age and was higher in rural areas (P < 0.01), primarily due to delayed care or being found dead, whereas treatment withdrawal was more common in urban settings.

Despite overall progress, significant urban-rural disparities persist. Targeted interventions and strengthened rural emergency care are needed.