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 treatmentseeking 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 treatmentseeking 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 individuallevel 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.