The epidemic and socioeconomic factors shock: a long-term dynamic analysis of equity in infectious disease healthcare in China.

OBJECTIVES

To analyze the changes in equity of health resources and service utilization (HRSU) for infectious diseases and to assess the impact of COVID-19 and its associated socioeconomic changes on this equity.

METHODS

This study utilized 14-year provincial panel data from 31 provinces in mainland China. Data were sourced from the China Health Statistics Yearbook (2011–2024). Equity in infectious disease HRSU was assessed using four key indicators. Specifically, health resource indicators included the number of CDC physicians and infectious disease beds, while service utilization indicators included the infectious disease outpatient rate and inpatient rate. A GDP-weighted Theil index was applied to analyze equity before and after the COVID-19 pandemic, and an Interrupted Time Series Analysis (ITSA) was conducted to quantify the pandemic’s impact on equity.

RESULTS

Post-COVID-19, the Theil index decreased for CDC physicians, infectious disease beds, utilization of outpatient service (UOS) and utilization of inpatient service (UIS). ITSA showed that after the pandemic, the pandemic had a statistically significant impact on the Theil index of infectious disease beds and UIS, with the difference between the pre-pandemic and post-pandemic slopes of -0.0132 and - 0.0077 (p < 0.001). Conversely, the Theil index of UOS decreased immediately after the pandemic (β2= -0.0106, p < 0.001), but there was no sustained effect.

CONCLUSION

Epidemic shocks have catalyzed policy responses, driving sustained gains in equity for infectious disease beds and inpatient service access, but only transient improvements in equity of UOS. The epidemic’s socio-economic impacts and inherent regional-economic disparities exert long-term effects on healthcare equity. A Health Priority Development Strategy could contribute to lowering infectious disease incidence and promoting sustained equity in health service utilization. CLINICAL TRIAL NUMBER: Not applicable.