Spatial behaviors of HFMD hospital visits across regions of various urbanicity levels in Nanchang, China

Abstract

Hand foot mouth disease (HFMD) is one of the widespread transmissible diseases that target preschool children, especially in urban regions in East Asia. Based on the mobile app data, a GIS automated regionalization method is used to define regions of various urbanicity levels. The variability of HFMD patients’ travel behaviors across these regions are examined by the complementary cumulative distribution functions (CCDFs). The travel burden in Nanchang increased as the patients’ residences moved toward regions of more rurality. Specifically, more urbanized regions near the city center (i.e., urban core and its surrounding urban) enjoyed better access to the healthcare service by spending an average of about 17-minute drive time. Patients residing in less urbanized regions such as suburbs and downtowns of surrounding rural counties either chose a nearby hospital or journeyed far to the region’s central Children’s Hospital, with average elevated travel time of 25 and 22 min, respectively. Those in rural areas travelled an average of 36 min, the longest among all regions. The study also finds a unique dual-peak pattern across two travel ranges in the study area due to the patients’ dilemma between pursuing high-quality hospitals and accommodating travel burden. Such a pattern mandates the adoption of a segmented regression approach to deriving the best-fitting CCDFs in most regions except for the rural.