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作者

Xijing Zhang Yu Chen Renhuai Liu Wei Fang Bingyu Qin Ronglin Jiang Yuan Gao Wenxiong Li Jianfeng Wu Mingyan Zhao Yi Yang Xiaochun Ma Bin Du Jiao Liu Xuan Song Dong Zhang Xinjing Gao Xiaodong Jin Jian Liu Fen Liu Lixia Liu Jinghui Li Siqing Ma Zhiyong Peng Yunbo Sun Songjing Shi Feng Shen Huanzhang Shao Tiehe Qin XianYao Wan Jinquan Wang Hongliang Wang Weidong Wu Haiying Wu Fang Xu Bin Xiong Xiangyou Yu Xiaojun Yang Lina Zhang Hongsheng Zhao Lipeng Zhang Xiangdong Guan Yan Kang & …Dechang Chen

作者单位

²¹Haikou Municipal People’s Hospital, Haikou, China ²⁶The Affiliated Hospital of Guizhou Medical University, Guiyang, China ⁷Department of Guangdong Clinical Research Center for Critical Care Medicine, The first Affiliated Hospital of Sun Yat-sen University, Guangdong, 510080, China ¹⁹The First Affiliated Hospital of Nanchang University, Nanchang, China ²²Qinghai Provincial People’s Hospital, Xining, China ⁴⁰West China Tianfu Hospital, Sichuan University, Chengdu, 610299, Sichuan, China ²⁷Guangdong Provincial People’s Hospital, Guangzhou, China ²Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China ¹⁴The First Hospital of Jilin University, Changchun, China ¹⁵Tianjin University Central Hospital, Tianjin, China ²⁵Fuzhou University Affiliated Fujian Provincial Hospital, Fuzhou, China ²⁰The Fourth Hospital of Hebei Medical University, Shijiazhuang, China ³⁷Xiangya Hospital of Central South University, Changsha, China ¹¹Peking Union Medical College Hospital, Beijing, China ³⁸Affiliated Hospital of Nantong University, Nantong, China ⁴Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310006, zhejiang, China ²⁸The First Affiliated Hospital of Dalian Medical University, Dalian, China ¹³Public Health Clinical Center Affiliated to Public Health Clinical Center, Shandong University, Jinan, Shandong, China ¹²Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China ¹Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xian, China ²³Zhongnan Hospital of Wuhan University, Wuhan, China ⁶Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China ³⁶General Hospital of Ningxia Medical University, Yinchuan, China ³⁹The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China ³³The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ¹⁶West China Hospital, Sichuan University, Chengdu, China ²⁹The First Affiliated Hospital of USTC, Hefei, China ¹⁷Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China ⁸The First Affiliated Hospital of Harbin Medical University, Harbin, China ¹⁰The First Affiliated Hospital of China Medical University, Shenyang, China ¹⁸Gansu Provincial Central Hospital, Lanzhou, China ³²The First Affiliated Hospital of Kunming Medical University, Kunming, China ³¹Bethune Hospital of Shanxi Province, Taiyuan, China ³Henan Provincial People’s Hospital, Zhengzhou, China ³⁰The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China ²⁴Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Jinan, China ⁹Zhongda Hospital Southeast University, Nanjing, China ⁵Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ³⁵The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China ³⁴The People’s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning, China

刊名

Critical Care

关键词

Critical Care Resource Nationwide Survey China

摘要

Background Critical care medicine plays a pivotal role in addressing life-threatening conditions; however, its development in China is hindered by resource scarcity and inequitable distribution. Existing studies have mostly focused on ICU bed numbers or selected regions, and have rarely provided a comprehensive, nationwide assessment of ICU beds, staffing and equipment using standardized methods, nor have they systematically quantified population-based equity of ICU resources. To address this e...更多

Background Critical care medicine plays a pivotal role in addressing life-threatening conditions; however, its development in China is hindered by resource scarcity and inequitable distribution. Existing studies have mostly focused on ICU bed numbers or selected regions, and have rarely provided a comprehensive, nationwide assessment of ICU beds, staffing and equipment using standardized methods, nor have they systematically quantified population-based equity of ICU resources. To address this evidence gap and describe the current landscape of critical care capacity in China, we conducted a nationwide survey of critical care resources. The survey aimed to describe the current status of resources, quantify population-based equity, and explore regional and hierarchical disparities that may affect access to critical care. Methods This cross-sectional survey was conducted from January 1, 2021, to December 31, 2023, encompassing public comprehensive hospitals, private hospitals, and specialty hospitals across 31 provinces in China. A total of 4,744 hospitals with a comprehensive ICU provided valid responses and were included in the analysis; the overall response rate among eligible hospitals invited through provincial health authorities was approximately 89.80%. The study focused on institutions with comprehensive intensive care units . Hospitals were stratified by level, including tertiary A and B, secondary A and B, and county-level hospitals. Data were collected using the “Critical Care Medicine Resource Survey Form” via Wenjuanxing, an online survey platform. The survey evaluated spatial distribution , equipment availability , and human resources . Responses were analyzed to identify regional and hierarchical variations in resource allocation and utilization. Findings Among the 4,744 hospitals, there were 83,632 operational ICU beds, corresponding to a national average of 5.95 ICU beds per 100,000 population. The total ICU workforce comprised 46,137 physicians and 134,056 nurses . Key equipment included 74,842 invasive ventilators, 13,389 non-invasive ventilators, 2,328 ECMO devices and 12,346 CRRT machines. ICU bed density varied from 2.29 to 10.53 beds per 100,000 population across provinces. The Gini coefficients for ICU beds, physicians and nurses allocated by population were all < 0.2, and there were no statistically significant differences in ICU beds or physician numbers per 100,000 population across provincial GDP or GDP per capita tiers. From 2015 to 2023, ICU beds increased by 80.0%, physicians by 73.4%, nurses by 61.5%, and ECMO devices by 512.8%. Although population-based distribution appeared relatively equitable, regions differed in absolute bed density, staffing ratios and geographic accessibility, and advanced technologies such as ECMO were available in 29.2% of hospitals. Interpretation Despite remarkable progress and optimization in ICU resource expansion, substantial gaps remain in China compared to developed countries, particularly regarding ICU bed densities and staffing ratios. Our analysis indicates relatively equitable distribution of ICU beds, physicians and nurses across provinces when assessed on a per population basis, as reflected by low Gini coefficients, but this population-based equity does not account for differences in disease burden, age structure, urban-rural composition or geographic accessibility. Accordingly, population-based equity of resources does not necessarily imply equity of access or adequacy of care. Moreover, this survey focused on resource quantity and did not assess perceived adequacy, organizational models or clinical outcomes, so no direct conclusions can be drawn about quality of care.These findings suggest that efforts to strengthen critical care in China should focus on improving resource density and staffing in underserved regions, enhancing accessibility in geographically vast areas, and promoting efficient use and regional sharing of advanced technologies such as ECMO through organized referral networks.收起

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