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Objective <p>To assess geographical disparities in hospice and palliative care (HPC) based on provider-reported practices across Chinese provinces and to identify associated socioeconomic and health system factors.</p> Study design <p>Descriptive cross-sectional study.</p> Methods <p>A large cross-sectional survey was conducted among 6,393 healthcare providers from 903 institutions across 87 pilot cities in 29 provinces using a multi-stage stratified sampling strategy. Provider practice levels were measured using a validated 14-item scale (Cronbach’s α = 0.98; score range 14–70), reflecting the frequency of essential HPC activities. Spatial patterns were assessed using Global and Local Moran’s I, and factors associated with practice levels were examined using Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR).</p> Results <p>The average practice level score was 53.35 ± 1.52. Significant spatial clustering of HPC practice levels was observed, with high-high clusters in Shandong and Yunnan and low-low clusters in Xinjiang. Higher practice levels were unexpectedly associated with lower GDP per capita (β = -0.07, 95%CI: -1.31 to -0.13) and fewer hospitals per 10,000 people (β = -0.67, 95%CI: -1.24 to -0.10).</p> Conclusions <p>Substantial geographic disparities in provider practice levels reveals inequities in HPC service delivery across China. These findings underscore the need for region-specific interventions, strengthened community-based services, and policy frameworks to improve equitable access to HPC nationwide.</p>

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Disparities in hospice and palliative care services: evidence of healthcare provider practice in various regions of China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月20日

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  • Shiwen Zhang,
  • Jingrong Wang,
  • Suhang Song,
  • Lisa Jing,
  • Xiaoyu Zhang,
  • Jianwei Shi,
  • Limei Jing

摘要

Objective

To assess geographical disparities in hospice and palliative care (HPC) based on provider-reported practices across Chinese provinces and to identify associated socioeconomic and health system factors.

Study design

Descriptive cross-sectional study.

Methods

A large cross-sectional survey was conducted among 6,393 healthcare providers from 903 institutions across 87 pilot cities in 29 provinces using a multi-stage stratified sampling strategy. Provider practice levels were measured using a validated 14-item scale (Cronbach’s α = 0.98; score range 14–70), reflecting the frequency of essential HPC activities. Spatial patterns were assessed using Global and Local Moran’s I, and factors associated with practice levels were examined using Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR).

Results

The average practice level score was 53.35 ± 1.52. Significant spatial clustering of HPC practice levels was observed, with high-high clusters in Shandong and Yunnan and low-low clusters in Xinjiang. Higher practice levels were unexpectedly associated with lower GDP per capita (β = -0.07, 95%CI: -1.31 to -0.13) and fewer hospitals per 10,000 people (β = -0.67, 95%CI: -1.24 to -0.10).

Conclusions

Substantial geographic disparities in provider practice levels reveals inequities in HPC service delivery across China. These findings underscore the need for region-specific interventions, strengthened community-based services, and policy frameworks to improve equitable access to HPC nationwide.