# Association Between Child Welfare Facilities and Distribution of Doctors in Japan: An Observational Study

## TL;DR

This study found that an increase in child welfare facilities in Japan is associated with a higher number of doctors per 100,000 people in local areas.

## Contribution

The study is the first to investigate the relationship between child welfare facilities and doctor distribution in Japan.

## Key findings

- A 10 or more increase in CWFs was linked to a 5.1 times higher odds of increased doctor density.
- The group with 10+ new CWFs had over 50 more doctors per 100,000 people than the group with no increase.
- The association remained significant after adjusting for economic and environmental factors.

## Abstract

Introduction

Child welfare facilities (CWFs) may be crucial in determining the distribution of doctors. However, research investigating the relationship between the CWFs and the distribution of doctors in Japan is limited. Therefore, this study examined the relationship between the CWFs and the distribution of doctors across secondary medical areas in Japan.

Methods

The study considered secondary medical areas in the Kinki and Chugoku regions. The change in the number of CWFs was represented by four categorical variables (0 or fewer, 1-4, 5-9, and 10 or more). The distribution of doctors was defined as the adjusted number of doctors per 100,000 people and was represented by three categorical variables and a continuous variable. We used ordinal logistic and linear regression analyses to assess the association between the change in the number of CWFs and the adjusted number of doctors per 100,000 people, after adjusting for medical expense subsidies for infants, retail sales floor area per population, income per taxpayer, and hours of sunlight.

Results

Across 71 secondary medical areas in Japan, a statistically significant association was observed between the group with an increase of 10 or more CWFs and the adjusted number of doctors per 100,000 people (odds ratio: 5.1; 95% confidence interval: 1.02 to 25.8). Additionally, this group had an increased adjusted number of doctors per 100,000 people, which was more than 50 higher than that of the group with no increase in CWFs.

Conclusion

These findings suggest that there may be an association between increasing CWFs and the adjusted number of doctors per 100,000 people.