Su Zhanhao, Xiang Li, Liu Zeye, Wu Hao, Li Shoujun, Chen Huiwen, Zhang Hao
State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Front Pediatr. 2021 May 7;9:555141. doi: 10.3389/fped.2021.555141. eCollection 2021.
Congenital heart disease (CHD) is the leading birth defect in China, and many patients require congenital heart surgery (CHS) to achieve optimal outcomes. However, the current landscape and population accessibility to specialist resources for CHS in China are unclear. Care facilities performing CHS were identified from the 2018 white book of Chinese cardiovascular surgery and were categorized as full or limited facilities based on specialist capacity. Census-based population data and road data were obtained from administrative sources. Service area analysis of all facilities was performed to estimate geographic accessibility. Of 93 facilities in 14 provinces and municipalities in northern China, only 30.1% had full specialist capacity. The shortage of pediatric cardiologists and mechanical circulatory support was the primary limiting factor. In 2018, 61.3% of facilities performed <200 CHS cases, and 31.6% of all CHS cases ( = 30,921) were performed in limited facilities with substantially lower volume than full-capacity facilities (median value: 85.0 vs. 368.0). Beijing had a disproportionately higher CHS volume (367 cases per million population) than other provinces. Of all children under 5 in northern China, only 12.9% live within 30 km (a typical half-day visit) of the service areas of all facilities. Compared to children from the eastern region (31.4%), 71.8% of children from the central region and 70.2% of children from the western region needed to travel >180 km (a typical overnight visit) to receive care in full-capacity facilities. Many facilities for CHS in northern China had limited specialist capacity, and many CHD patients received suboptimal surgical care. Policy measures should address the significant geographic disparities to receive high-quality surgical care among disadvantaged patients.
先天性心脏病（CHD）是中国最主要的出生缺陷疾病，许多患者需要接受先天性心脏手术（CHS）以获得最佳治疗效果。然而，目前中国先天性心脏手术专科资源的现状以及人群可及性尚不清楚。从《2018中国心血管外科白皮书》中确定了开展先天性心脏手术的医疗机构，并根据专科能力将其分为全面型或有限型机构。基于人口普查的人口数据和道路数据来自行政部门。对所有机构进行服务区域分析以评估地理可及性。在中国北方14个省和直辖市的93家机构中，只有30.1%具备全面的专科能力。儿科心脏病专家和机械循环支持的短缺是主要限制因素。2018年，61.3%的机构开展的先天性心脏手术病例数少于200例，所有先天性心脏手术病例的31.6%（n = 30,921）在有限型机构进行，其手术量远低于全面型机构（中位数：85.0对368.0）。北京的先天性心脏手术量（每百万人口367例）比其他省份高得多。在中国北方所有5岁以下儿童中，只有12.9%居住在所有机构服务区域30公里范围内（通常为半天的行程）。与东部地区的儿童（31.4%）相比，中部地区71.8%的儿童和西部地区70.2%的儿童需要前往180公里以上（通常为过夜行程）才能在全面型机构接受治疗。中国北方许多先天性心脏手术机构的专科能力有限，许多先天性心脏病患者接受的手术治疗效果欠佳。政策措施应解决弱势患者在获得高质量手术治疗方面存在的显著地理差异问题。
