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. 2021 Jun;17(3):317-325.
doi: 10.1007/s12519-021-00433-0. Epub 2021 Jun 7.

Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in China in 2014

Xi Zhang  1   2 , Jian Wang  1 , Li-Su Huang  1   3 , Xin Zhou  2 , Julian Little  4 , Therese Hesketh  5   6 , Yong-Jun Zhang  1   3 , Kun Sun  7   8
Affiliations

Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in China in 2014

Xi Zhang et al. World J Pediatr. 2021 Jun.

Abstract

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.

Keywords: China; Human resources for health; Inequality; National survey; Pediatrician.

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Conflict of interest statement

The authors declared that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Adjusted ORs of high U5MRs (≥ 18‰) in China in 2014. The solid curve represents the multivariate-adjusted ORs calculated by restricted cubic splines. The reference value (red line: OR = 1.0) was set at 0.50 for PPTC (a), 100 for pediatricians per 10,000 km2 (b), and 20 for tertiary and secondary hospitals per 10,000 km2 (c). ORs for high U5MRs were estimated using logistic regression models adjusted for gross domestic product per capita, surface area, child population (except PPTC), type of climate, altitude, and proportion of the population engaged in agriculture. OR odds ratio, PPTC pediatricians per thousand children, U5MR under-five mortality rate
Fig. 2
Fig. 2
Combined associations of pediatricians per 1000 children and pediatricians per 10,000 km2 (a) and number of tertiary and secondary hospitals per 10,000 km2 (b) at risk of a high U5MR. ORs for high U5MRs were estimated using logistic regression models adjusted for gross domestic product per capita, surface area, child population size, type of climate, altitude, and proportion of population engaged in agriculture. OR odds ratio, U5MR under-five mortality rate
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