Spatial and Causal Effects of Sports Facilities on Medical FacilityDevelopment: Evidence from Jiangxi Province, China

Spatial and Causal Effects of Sports Facilities on Medical FacilityDevelopment: Evidence from Jiangxi Province, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Spatial and Causal Effects of Sports Facilities on Medical FacilityDevelopment: Evidence from Jiangxi Province, China Rong Zhang, Xiaoyi Hu, Chonghui Jiang, Jiacheng Li, Xiaoji Zeng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7825276/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract This study investigates the spatial and causal relationship between sports and medical facilities in Jiangxi Province, China, from 2012 to 2023. Spatial distribution analysis reveals a persistent concentration of both sports and medical facilities in urban areas, with a significant increase in both sectors after 2016. The number of sports facilities POIs increased from 18,871 in 2012 to 44,028 in 2023, while the number of medical facilities POIs grew from 3,059 to 5,916 over the same period. We observe gradual improvements in coverage at the county level, with rural areas showing significant growth in both sports and medical facilities. Using multi-year Points of Interest (POI) data at 1 ~ km resolution, we integrate spatial statistical analysis with modern causal machine learning methods, including Double Machine Learning (DML) and Causal Forest (CF), to estimate both average and heterogeneous treatment effects. The results demonstrate a consistently positive correlation between the growth of sports and medical facilities. Contemporaneous causal effects show an increase from 1.04 in 2013 to 2.18 in 2023, while lagged effects range from 1.38 in 2013 to 2.15 in 2023. Heterogeneity analysis indicates stronger effects in economically developed areas, with a particularly large impact in regions with a higher ageing population. Robustness checks, including placebo tests, alternative model specifications, and adjustments for spatial autocorrelation, confirm the reliability of our findings. The study suggests that integrated planning of sports and medical facilities, tailored to regional conditions, can enhance public health infrastructure and contribute to the goals of the ``Healthy China 2030'' strategy. Earth and environmental sciences/Environmental sciences Earth and environmental sciences/Environmental social sciences Health sciences/Health care POI causal inference Double Machine Learning Causal Forest XGBoost SHAP Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Mar, 2026 Reviews received at journal 12 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 05 Dec, 2025 Editor assigned by journal 05 Dec, 2025 Editor invited by journal 27 Nov, 2025 Submission checks completed at journal 31 Oct, 2025 First submitted to journal 31 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7825276","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":555869147,"identity":"f31f92de-73e6-425f-ad4b-a2c99c0aa13a","order_by":0,"name":"Rong Zhang","email":"","orcid":"","institution":"Jiangxi University of Finance and Economics","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Zhang","suffix":""},{"id":555869148,"identity":"ac43fd39-5d79-47c3-9235-975536cbc574","order_by":1,"name":"Xiaoyi Hu","email":"","orcid":"","institution":"Jiangxi University of Finance and 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Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"POI, causal inference, Double Machine Learning, Causal Forest, XGBoost, SHAP","lastPublishedDoi":"10.21203/rs.3.rs-7825276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7825276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study investigates the spatial and causal relationship between sports and medical facilities in Jiangxi Province, China, from 2012 to 2023. Spatial distribution analysis reveals a persistent concentration of both sports and medical facilities in urban areas, with a significant increase in both sectors after 2016. The number of sports facilities POIs increased from 18,871 in 2012 to 44,028 in 2023, while the number of medical facilities POIs grew from 3,059 to 5,916 over the same period. We observe gradual improvements in coverage at the county level, with rural areas showing significant growth in both sports and medical facilities. Using multi-year Points of Interest (POI) data at 1\u0026thinsp;~\u0026thinsp;km resolution, we integrate spatial statistical analysis with modern causal machine learning methods, including Double Machine Learning (DML) and Causal Forest (CF), to estimate both average and heterogeneous treatment effects. The results demonstrate a consistently positive correlation between the growth of sports and medical facilities. Contemporaneous causal effects show an increase from 1.04 in 2013 to 2.18 in 2023, while lagged effects range from 1.38 in 2013 to 2.15 in 2023. Heterogeneity analysis indicates stronger effects in economically developed areas, with a particularly large impact in regions with a higher ageing population. Robustness checks, including placebo tests, alternative model specifications, and adjustments for spatial autocorrelation, confirm the reliability of our findings. The study suggests that integrated planning of sports and medical facilities, tailored to regional conditions, can enhance public health infrastructure and contribute to the goals of the ``Healthy China 2030'' strategy.\u003c/p\u003e","manuscriptTitle":"Spatial and Causal Effects of Sports Facilities on Medical FacilityDevelopment: Evidence from Jiangxi Province, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 10:35:23","doi":"10.21203/rs.3.rs-7825276/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-28T19:24:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T15:19:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266172780933332372197486473750726418488","date":"2026-02-28T18:06:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T10:09:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237649816684679960443141377928929726662","date":"2026-01-07T09:17:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T11:21:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-05T11:13:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-27T10:40:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-31T17:28:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-10-31T17:25:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"017d054e-5eec-4066-8168-01d9f701b5ad","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59163970,"name":"Earth and environmental sciences/Environmental sciences"},{"id":59163971,"name":"Earth and environmental sciences/Environmental social sciences"},{"id":59163972,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-04-17T05:09:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 10:35:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7825276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7825276","identity":"rs-7825276","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}