Nakamura Akihisa, Kotani Kazuhiko, Hatakeyama Shuji, Obayashi Senichi, Nagai Ryozo
Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan.
Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan.
JMA J. 2023 Oct 16;6(4):397-403. doi: 10.31662/jmaj.2023-0052. Epub 2023 Sep 27.
As the characteristics of coronavirus disease 2019 (COVID-19) vary across regions and countries, the relationship between regional characteristics, such as the distribution of physicians and hospital beds, and COVID-19 mortality was assessed in the 47 prefectures of Japan.
This ecological study was based on the number of patients with COVID-19 by prefecture during the seventh wave of COVID-19 in Japan (June-October 2022). COVID-19 mortality was indexed as the number of COVID-19 deaths divided by the number of new COVID-19 cases. Data on regional factors, such as population size, number of physicians, and hospital beds by prefecture, were obtained from government statistics. Correlations between regional characteristics and COVID-19 mortality index were analyzed by dividing the 47 prefectures into two groups at the median level of population size (more populated group [MPG] ≥ 1.6 million and less populated group [LPG] < 1.6 million).
The COVID-19 mortality index (mean 12.7, minimum-maximum: 4.7-25.7) was correlated negatively with the number of physicians per hospital bed (r = -0.386, = 0.007) and positively with the number of long-term care facilities per 10,000 population (r = 0.397, = 0.006) and aging rate (the proportion of population aged ≥ 65 years) ( = 0.471, = 0.001). The two groups varied with respect to the number of physicians (28.7 physicians in the LPG vs. 26.1 physicians in the MPG, = 0.038) and hospital beds (156 beds in the LPG vs. 119 beds in the MPG, < 0.001) per 10,000 population. In the multiple regression analysis, the COVID-19 mortality index was correlated negatively with the number of physicians per hospital bed ( = -0.543, = 0.024) and positively with the aging rate ( = 0.434, = 0.032) in the LPG, with nonsignificant correlations in the MPG.
The data may suggest a need of improvement in the distribution of physicians and hospital beds in the healthcare system in regions with smaller and older populations to reduce the rate of COVID-19.
由于2019冠状病毒病（COVID-19）的特征在不同地区和国家有所不同，我们在日本的47个县评估了区域特征（如医生和医院床位的分布）与COVID-19死亡率之间的关系。
这项生态学研究基于日本COVID-19第七波疫情期间（2022年6月至10月）各县COVID-19患者的数量。COVID-19死亡率以COVID-19死亡人数除以新增COVID-19病例数来表示。各县的人口规模、医生数量和医院床位数等区域因素的数据来自政府统计。通过将47个县按人口规模中位数分为两组（人口较多组[MPG]≥160万，人口较少组[LPG]<160万），分析区域特征与COVID-19死亡率指数之间的相关性。
COVID-19死亡率指数（均值12.7，最小-最大值：4.7-25.7）与每张医院床位的医生数量呈负相关（r = -0.386，P = 0.007），与每万人口长期护理设施数量呈正相关（r = 0.397，P = 0.006），与老龄化率（65岁及以上人口比例）呈正相关（r = 0.471，P = 0.001）。两组在每万人口的医生数量（LPG组为28.7名医生，MPG组为26.1名医生，P = 0.038）和医院床位数（LPG组为156张床位，MPG组为119张床位，P<0.001）方面存在差异。在多元回归分析中，LPG组的COVID-19死亡率指数与每张医院床位的医生数量呈负相关（P = -0.543，P = 0.024），与老龄化率呈正相关（P = 0.434，P = 0.032），而在MPG组中相关性不显著。
这些数据可能表明，在人口较少且老龄化的地区，医疗系统中医生和医院床位的分布需要改善，以降低COVID-19的发病率。
