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

Zhang, Xi; Wang, Jian; Huang, Li-Su; Zhou, Xin; Little, Julian; Hesketh, Therese; Zhang, Yong-Jun; Sun, Kun

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. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12519-021-00433-0) contains supplementary material, which is available to authorized users.