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

作　　者：Xi Zhang Jian Wang Li-Su Huang Xin Zhou Julian Little Therese Hesketh Yong-Jun Zhang Kun Sun 

机构地区：[1]Department of Pediatrics,Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine,Shanghai,China [2]Clinical Research Unit,Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine,Shanghai,China [3]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health,Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine,Shanghai,China [4]School of Epidemiology and Public Health,University of Ottawa,Ottawa,Canada [5]Institute for Global Health,University College London,London,United Kingdom [6]Institute for Global Health,Zhejiang University,Hangzhou China

出　　处：《World Journal of Pediatrics》2021年第3期317-325,共9页世界儿科杂志（英文版）

基　　金：supported by the Shanghai Municipal Commission of Health and Family Planning(2016ZB0103).

摘　　要：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 km^(2) were categorized into quartiles.The highest quartiles were used as reference.Results The median values of PPTC and pediatricians per 10,000 km^(2) 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 km^(2),respectively,than in counties with≥500 physicians per 10,000 km^(2).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.

关 键 词：China Human resources for health INEQUALITY National survey PEDIATRICIAN 

分 类 号：R195[医药卫生—卫生统计学]