Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016

Abstract

Background Driven by the government’s firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements. Methods Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level. Results The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = − 0.112, 95% CI: − 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123–2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009. Conclusions This study provided empirical evidences on China’s impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.

Temporal Analysis of Social Determinants Associated with COVID-19 Mortality

“…In contrast, insufficient sleep has been linked to an increased chance of severe chronic diseases like diabetes [58], and we find that this destructive effect may extend to COVID-19. The ratio of hospital beds per population is one measure of available healthcare resources, and a higher ratio is traditionally implicated with more urbanization [13,61], so our results may suggest an increased risk of COVID-19 in urban environments, rather than a direct relationship between hospital beds availability and increased COVID-19 mortality rates.…”

Identification and Prioritization of Local Indicators of Hospital Bed Allocation in Iran

“…This condition has the most significant effect on rural areas and vulnerable populations such as the elderly and the poor [41]. In this regard, a study in China shows that equal geographical distribution of hospital beds reduced maternal mortality rates [48]. Therefore, based on health outcomes, the needs of a geographical region should be assessed to determine whether the demand of the population, especially vulnerable and marginalized groups, is sufficiently met.…”

Spatially Illustrating Leisure Agriculture: Empirical Evidence from Picking Orchards in China

“…The range of a Gini coefficient is 0 to 1. The perfect inequality value is 1, while 0 indicates perfect equality [7]. This study adopts a Gini coefficient to measure the interprovincial distribution of sightseeing picking orchards.…”

“…to meet their increasing cultural and psychological needs, such as viewing their cultural heritage, experiencing the traditional life, and viewing beautiful natural scenery, which contributes towards a higher quality of life [1][2][3][4][5]. In the context of rapid urbanization globally, urban dwellers are predicted to account for 68% of the worldwide population, a growing number of urban residents desire to leave the city and get close to nature in the countryside as rapid urbanization leads to an increased distance to nature for many people [6,7]. Rapid urbanization and postmodernism have given birth to the rural idyll of the urban, just as the rural signifies idyllic, pure, tranquil authenticity and original, idealized, traditional agriculture [8,9].…”