National variation in patterns of bone disease treatment-seeking behaviors: A study of more than 50,000 hospital admissions between 2008 and 2021

Understanding disease treatment-seeking behaviors is a fundamental issue for national and regional healthcare management. However, treatment-seeking behaviors are complex and affected by various factors, including disease incidence, healthcare resources, and population accessibility to hospitals. Geospatial analysis is a practical approach to investigating treatment-seeking behaviors. Still, methods and cases are limited due to the lack of long-term data, interdisciplinary knowledge, and data analytic techniques. We develop a new paradigm for investigating spatial patterns and factors affecting bone disease treatment-seeking behaviors. We leverage consecutive long-term records of over 50,000 nationwide bone disease patients outside Beijing who had surgeries in a prestigious hospital in Beijing, China. Five categories of patient individual-level geographical and environmental variables are derived from multi-source remote sensing and geospatial data to explain treatment-seeking behaviors. First, we develop a scaling approach to assess the relationships between bone patients and population migration. Next, we develop a treatment-seeking index to measure treatment-seeking behaviors and develop spatial models to identify their regional disparities, i.e., hotspots and coldspots. Finally, we develop spatial heterogeneity models to explore the complex factors affecting treatment-seeking behaviors. Results show that the developed paradigm is effective in examining national variations of the patterns of disease treatment-seeking behaviors. We find that (i) population migration is an effective predictor of the treatment-seeking behaviors of bone patients, (ii) significant hotspots and coldspots are identified for informing regional disparities, and (iii), multiple types of factors affecting the treatment-seeking behaviors through a geospatially overlapped approach. This study pioneers the development of geospatial models and implementation of patient individual-level data derived from satellite remote sensing for large-scale disease treatment-seeking behaviors assessment. The proposed paradigm provides solid evidence for previous and future policies and actions to address the regional inequality of disease treatments.