Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China

Abstract

Background: The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China.

Methods: Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores.

Results: From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d₀] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou.

Conclusions: This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.

Keywords: 2SFCA method; Inequality; Rabies PEP clinics; Spatial accessibility.

Fig. 1

The incidence of rabies exposure and clinic distribution. (A) The total incidence of Category II and Category III exposure by district during 2020–2022. (B) Clinic distribution (red dots) and the average number of people exposed to rabies () per day during 2020–2022. Abbreviations LW = Liwan; YX = Yuexiu; HZ = Haizhu; TH = Tianhe; BY = Baiyun; HP = Huangpu; PY = Panyu; HD = Huadu; NS = Nansha; ZC = Zengcheng; CH = Conghua

Fig. 2

Accessibility analysis of rabies-exposed patients to rabies PEP clinics at different scenarios in Guangzhou. (A) Spatial accessibility score of each subdistrict/town under scenario1, d₀ = 30 min; (B) Spatial accessibility score of each subdistrict/town under scenario 2, d₀ = 45 min; (C) Spatial accessibility score of each subdistrict/town under scenario 3, d₀ = 60 min

Fig. 3

Lorenz curve based on the accessibility of exposed individuals at the subdistrict level in Guangzhou

Fig. 4

Cluster analysis under three scenarios with Anselin Moran’s I analysis. (A) Scenario 1: d₀ = 30 min; (B) Scenario 2, d₀ = 45 min; (C) Scenario 3, d₀ = 60 min. (NS: Not Significant)