Spatial Distribution of Community Oral Healthcare Resources and Their Association with Oral Health Status in Shanghai, China

Spatial Distribution of Community Oral Healthcare Resources and Their Association with Oral Health Status in Shanghai, 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 Research Article Spatial Distribution of Community Oral Healthcare Resources and Their Association with Oral Health Status in Shanghai, China Wenjie Song, Xiaoli Zeng, Hao Zhang, Dongxin Da, Junjie Xie, Shuran Yao, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7019977/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background This study aimed to assess the distribution and equity of community oral healthcare resources in Shanghai and to examine their associations with population-level oral health indicators, including dental caries prevalence and periodontal health rate. Methods Data were collected from 249 community health service centers across 16 administrative districts in Shanghai, China, encompassing human resources, equipment allocation, and the implementation of public oral health programs. Additionally, clinical oral health data were obtained from sampled residents in selected districts. The equity of resource distribution was evaluated using Gini coefficients, Lorenz curves, and Theil indices. Pearson correlation analysis was conducted to explore the associations between resource indicators and oral health outcomes. Results A total of 249 community health service centers, located across 16 districts in Shanghai, were surveyed. The dental public health workforce was predominantly female (78.2%) and relatively young, with 63.9% of the workforce aged 44 or younger. While 76.6% held a bachelor’s degree or higher, only 4.2% had senior professional titles. Suburban districts held 66.02% of registered dental chairs and 57.68% of clinic space. Also, they had higher counts of both basic equipment (e.g., dental chairs, ultrasonic scalers) and high-end devices such as implant systems, microscopes, and laser therapy units (see Table 3). The Gini coefficients for independent dental departments were 0.151 by geography, 0.357 by population, and 0.362 by economic output. For dental chairs, the corresponding values were 0.356, 0.420, and 0.400. The Theil index for the geographic distribution of dental chairs was 0.7128; suburban and urban values were 0.3809 and 0.0359, respectively. Suburban areas contributed 92.66% to the overall geographic inequality, while urban areas contributed 7.34%. The correlation between the Dental Manpower Index and periodontal health rate was 0.881 (p = 0.020); for the dentist-to-population ratio, the correlation was 0.870 (p = 0.024). Conclusions Notable spatial disparities exist in the allocation of community oral healthcare resources in Shanghai, which may influence population oral health outcomes. Policy adjustments are recommended to enhance high-quality resource coverage in underserved areas and strengthen primary care capacity, thereby promoting oral health equity and efficiency. Community oral healthcare resources Health resource allocation Gini coefficient Lorenz curve Theil index Caries prevalence Oral health status Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Oral health is a crucial component of overall health, significantly affecting individuals' quality of life, work efficiency, and social interactions ( 1 , 2 ). The World Health Organization (WHO) has explicitly included oral health as a key category in the Global Burden of Disease Report and advocates for health equity through optimized resource allocation ( 3 , 4 ). However, a marked global disparity persists in the distribution of oral healthcare resources, particularly between economically underdeveloped and developed regions, which limits access to essential oral healthcare services for vulnerable populations ( 5 – 7 ). Although China’s overall healthcare resources are relatively balanced, wealthier regions receive a larger share of human and financial investments. Meanwhile, hospitals with sufficient resources are predominantly concentrated in economically developed areas, whereas grassroots healthcare institutions in impoverished regions often face resource shortages. This imbalance in distribution may further widen disparities in healthcare utilization between affluent and disadvantaged populations ( 8 ). Since the launch of China’s new round of healthcare reform in 2009, multiple measures have been implemented to optimize resource allocation and enhance healthcare equity, including expanding urban-rural health insurance coverage and strengthening primary healthcare networks to reduce regional and urban-rural disparities ( 9 , 10 ). Specifically, the Healthy China 2030 Plan emphasizes prioritizing the allocation of medical resources to primary care to improve overall public health ( 11 ). As a major economic and social hub in China, Shanghai's community healthcare system plays a critical role in providing primary healthcare services to all residents. Recent statistical data indicate a significant expansion in the total number of community hospitals; however, disparities in resource distribution remain ( 12 , 13 ). For example, suburban districts have gradually improved their allocation of basic oral healthcare resources. At the same time, central urban areas concentrate more advanced diagnostic equipment and high-end medical resources to cater to the diverse needs of regional populations ( 10 ). Furthermore, with population aging and rising oral health demands, the supply-demand gap in community healthcare resources is becoming increasingly prominent ( 14 ). Optimizing the distribution of healthcare resources can not only improve equity and accessibility but also reduce the burden of disease and enhance population health indicators ( 15 ). However, research on the equity of community oral healthcare resource distribution in Shanghai and its association with residents’ oral health outcomes remains limited. This study aims to fill this gap by quantitatively analyzing the current status and equity of oral healthcare resource allocation and exploring its potential association with residents’ health outcomes, providing scientific evidence for policy formulation. Research Methods 5.1. Data Sources The data of this study were primarily obtained from the following three sources: Healthcare Workforce and Facility Survey: The survey covered all 16 administrative districts in Shanghai, comprising seven urban districts (Huangpu, Xuhui, Changning, Jing’an, Putuo, Hongkou, and Yangpu) and nine suburban districts (Baoshan, Jiading, Jinshan, Minhang, Songjiang, Qingpu, Fengxian, Pudong New Area, and Chongming), and included a total of 249 community health service centers surveyed. Oral Health Survey: Data were derived from the 2021 China Nutrition and Chronic Disease Surveillance – Shanghai Oral Health Survey. Using a cluster-sampling technique, six districts (Hongkou, Jing’an, Minhang, Pudong New District, Putuo, and Xuhui) were randomly chosen from the city’s 16 administrative districts. Within each selected district, four kindergartens, three middle schools, and three village (residents) committees served as sampling clusters. From each kindergarten, 50 five-year-old children were randomly selected (totaling 1,200 children); from each middle school, 50 twelve-year-old students were randomly selected (totaling 900 adolescents); and from each village (residents) committee, 100 adults across two age cohorts (35–44 and 65–74 years) were randomly selected (totaling 1,800 adults). Written informed consent was obtained from all participants or their legal guardians. Public Statistical Data: Data on geographic area, resident population, and Gross Domestic Produgeographic area, resident population, and Gross Domestic Product (GDP) for each administrative district were obtained from the Shanghai Statistical Yearbook 2023 and the 2023 National Economic and Social Development Statistical Bulletins of individual districts. The survey instruments for the healthcare workforce and oral health examination data collection were adapted from the National Oral Health Epidemiological Survey conducted in China in 2015( 16 ). 5.2. Data Collection and Quality Control Before the oral health survey, all staff underwent centralized training, and inter-examiner reliability was assessed during the survey process (Kappa value > 0.8). The examination was conducted using a Community Periodontal Index (CPI) probe, a flat mouth mirror, and portable lighting, which combined visual inspection and probing under artificial light. 5.3. Data Analysis Methods 5.3.1. Resource Distribution Assessment: Lorenz Curve The Lorenz curve, introduced by American statistician Max O. Lorenz in 1905, is a graphical representation used to illustrate the distribution of resources or income within a population ( 17 ). The x-axis represents the cumulative proportion of the population, while the y-axis represents the cumulative proportion of resources. When resources are perfectly equally distributed, the curve follows the diagonal line of equality. The greater the deviation from this line, the higher the level of inequality in resource distribution. In this study, Lorenz curves were plotted to analyze the equity of oral healthcare resource distribution in Shanghai, including the number of community hospitals with independent dental departments and the number of registered dental chairs. The x-axis represents the cumulative percentage of geographic area, population, and economic output (GDP), while the y-axis represents the corresponding cumulative percentage of oral healthcare resources. Gini Coefficient : The Gini coefficient, derived from the Lorenz curve, provides a quantitative measure of the equity in resource distribution. Its values range from 0 to 1, where 0 indicates perfect equality and 1 indicates extreme inequality. A Theil index value is generally interpreted as follows: 0–0.2 indicates a highly equitable state; 0.2–0.3, a relatively equitable state; 0.3–0.4, a moderately equitable state; values above 0.4 represent an alert state; 0.5–0.6, an inequitable state; and values above 0.6 indicate a highly inequitable state( 18 ). In this study, the Gini coefficient was calculated based on geographic area, population distribution, and economic output, assessing disparities in the number of community hospitals with independent dental departments and the number of registered dental chairs. The combination of the Lorenz curve and the Gini coefficient offers a clear and accurate analytical framework for evaluating the distribution of oral healthcare resources across geographic, demographic, and economic dimensions. Theil Index : The Theil index, initially proposed by econometrician Henri Theil from Erasmus University Rotterdam ( 19 ), has also been widely used in studies assessing the equity of healthcare resource distribution. To further analyze the equity of oral healthcare resource distribution in Shanghai’s community healthcare system, this study applies information entropy theory to compute the resource distribution disparity index from two perspectives: geographic distribution and service population distribution. The analysis covers three levels: citywide distribution, intra-urban and intra-suburban disparities, and inter-district disparities, while also evaluating the extent to which disparities between urban and suburban districts contribute to overall inequality. 5.3.2 Health Data Analysis Data entry was performed using EpiData 3.2, and statistical analysis was conducted using SPSSAU. (Version 25.0) [Online Application Software] ( 20 ). The analysis included the frequency and proportion of oral public health workforce and hardware equipment, as well as the mean and standard deviation of caries prevalence (DMFT index) and periodontal health rate among 5-year-old and 12-year-old children and adults in urban and suburban areas. Key indicators analyzed included: Dentist-to-population ratio (number of dentists per 100,000 people), Proportion of healthcare workers engaged in dental prevention programs, Percentage of healthcare workers with a bachelor's degree or higher, Proportion of senior and intermediate-level dentists. Additionally, the Dental Manpower Index (DMI) was introduced to quantify the allocation of human resources. The index was calculated as: DMI = (1 × Dentists + 1 × Oral Physicians + 0.5 × Dental Assistants + 0.25 × Dental Hygienists + 0.5 × Dental Technicians + ……) ÷ Total Population of the Country or Region ( 21 ). Pearson correlation analysis was used to examine the relationship between resource allocation and oral health indicators, including caries prevalence and periodontal health rates. A P-value < 0.05 was considered statistically significant. Research Results 6.1. Current Status of Community Oral Healthcare Resources 6.1.1. Structure of Healthcare Workforce The oral preventive care teams in community hospitals across Shanghai display distinct features in terms of human resources. The teams are predominantly composed of licensed practitioners. Females constitute 78.2% of the workforce, substantially exceeding the proportion of males (21.8%). In terms of age distribution, staff aged 44 years and younger account for 63.9%, representing the core workforce; those aged 45–59 years comprise 33.7%, while those aged 60 years or above make up only 2.4% (see Table 1). Regarding educational background, 76.6% of staff hold a bachelor’s degree or higher, with 74.5% holding a bachelor’s degree and 2.1% possessing a postgraduate degree. The professional title structure indicates a significant shortage of senior-level professionals, with only 4.2% holding senior professional titles and 37.3% holding intermediate titles. Table 1. Structure of Health Professionals Involved in Oral Health Prevention in Shanghai Community Hospitals, 2023 N Proportion (%) Gender Male 208 21.8 Female 745 78.2 Age ≤ 44 years 609 63.9 45-59 years 321 33.7 60-74 years 23 2.4 Grouping Public Health Group 264 27.7 Nursing Group 42 4.4 Dentistry Group 630 66.1 Outpatient Group 8 0.8 Specialty Group 9 0.9 Educational Background Secondary school and below 37 3.9 Associate degree 186 19.5 Bachelor's degree 710 74.5 Above a bachelor's degree 20 2.1 Professional Type Physicians 572 60 Nurses 338 35.5 Dental Technicians 27 2.8 Others 16 1.7 Work Scope Dental Prevention Services 280 29.4 Both Areas Involved 256 26.9 Dental Outpatient Services 417 43.8 Post-Tax Income (in thousand CNY) X＜10 124 13 10≤X＜15 417 43.8 15≤X＜20 320 33.6 20≤X＜25 68 7.1 25≤X＜30 19 2 X≥30 4 0.4 Administrative Region Central Urban Area 304 31.9 Suburban Area 649 68.1 Professional Title Senior Physicians 40 4.2 Intermediate Physicians 355 37.3 Junior Physicians 109 11.4 Physicians without Title 27 2.8 Intermediate Technicians 15 1.6 Junior Technicians 22 2.3 Senior Nurses 6 0.6 Intermediate Nurses 206 21.6 Junior Nurses 134 14.1 Others 39 4.1 6.1.2. Distribution of Equipment and Facilities The overall configuration of oral healthcare equipment in Shanghai’s community hospitals is relatively advanced; however, there are significant differences between urban and suburban areas. The number of registered dental chairs in suburban districts is 433, accounting for 66.02%, while in central urban districts, the number is 233, representing 33.98% (see Table 2). Suburban districts not only account for a larger share of basic equipment such as dental chairs and ultrasonic scalers but also significantly surpass urban districts in the availability of high-end devices, including implant systems, microscopes, and laser therapy units (see Table 3). In terms of clinic space utilization, suburban districts have a total area of 14,589.71 square meters (57.68%), while central urban districts have a total area of 10,693.31 square meters (42.32%) (see Table 2). Table 2: Licensing and Facility Area of Community Hospitals in Shanghai (2023) Independent Dental Departments Registered Dental Chairs Restricted Technology Licenses (e.g., Dental Implantation Accreditation) Clinic Area in Community Hospitals (㎡) N Proportion (%) N Proportion (%) N Proportion (%) S/m² Proportion (%) Region Urban 74 34.58% 233 33.98% 202 34.48% 10693.31 42.32% Suburban 140 65.42% 433 66.02% 108 65.52% 14589.71 57.68% Table 3: Oral Healthcare Equipment in Shanghai’s Community Hospitals (2023) Total Central Urban Area (N/%) Suburban Area (N/%) Dental Equipment Configuration Dental CT Scanner 17 6/35.29% 11/64.71% X-ray Panoramic Machine 74 23/31.13% 51/68.87% X-ray Intraoral Machine 167 60/35.92% 107/64.08% Implant System 13 2/15.38% 11/84.62% Ultrasonic Bone Scalpel 15 7/46.67% 8/53.33% Microscope 3 1/33.33% 2/66.67% Thermoforming Machine 37 13/35.14% 24/64.86% Rotary Endodontic Treatment Device 140 47/33.59% 93/66.41% Root Canal Length Measuring Instrument 237 84/35.44% 153/64.56% Pulp Vitality Tester 57 21/36.84% 36/63.16% Ultrasonic Scaler 405 150/37.04% 255/62.96% Laser Therapy Device 5 0/0% 5/100% Intraoral Scanner 3 1/33.33% 2/66.67% Electrosurgical Knife 27 11/40.74% 16/59.26% Head-mounted Magnifying Glass 16 8/50% 8/50% Thermoplastic Gutta-Percha Obturation Device 35 14/40% 21/60% Comprehensive Treatment Chair 611 205/33.56% 406/66.44% Light-curing Lamp 506 159/31.43% 347/68.57% Portable Dental Chair 197 40/20.30% 157/79.70% Small Mobile Multifunctional Equipment 153 27/17.65% 126/82.35% Amalgamator 210 76/36.19% 134/63.81% Vacuum Steam Sterilizer 272 96/35.29% 176/64.71% Enzyme Washer 218 74/33.94% 144/66.06% Mobile UV Disinfection Device 242 60/24.79% 182/75.21% 6.2 Equity Assessment of Community Oral Healthcare Resource Distribution This study employed the Gini coefficient, Lorenz curve, and Theil index to comprehensively evaluate the equity of community oral healthcare resource distribution in Shanghai. The assessment focused on three key dimensions: the number of community hospitals with independent dental departments, the number of registered dental chairs, and the usable area of dental departments. The results reveal disparities and characteristics of equity in resource distribution across geographic, population, and economic dimensions. 6.2.1 Assessment Based on the Gini Coefficient The Gini coefficient, as a key quantitative metric for evaluating the equity of resource allocation, highlights the distributional characteristics of different resources across geographic, demographic, and economic dimensions (see Table 4). In Shanghai, the Gini coefficients for hospitals with stand-alone dental departments were 0.151, 0.357, and 0.362 based on geographic area, population, and economic distribution, respectively. For the number of registered dental chairs, the Gini coefficients were 0.356, 0.420, and 0.400, while those for the allocated clinical space of dental departments were 0.371, 0.448, and 0.430, respectively. Table 4: Gini Coefficients of Per Capita Community Oral Healthcare Resources in Shanghai by Geographic, Population, and Economic Distribution Healthcare Resource Geographic Population GDP Community hospitals with independent dental departments 0.151 0.357 0.362 Number of registered dental chairs 0.356 0.420 0.400 Usable area of dental departments 0.371 0.448 0.430 6.2.2 Assessment Based on the Lorenz Curve The distribution of clinical space for dental departments by geographic area, population, and economic status is depicted in Figure 1. The distribution of hospitals with stand-alone dental departments, according to these dimensions, is shown in Figure 2. The distribution of registered dental chairs is presented in Figure 3. The distribution patterns were broadly similar across all three indicators and corresponded to the results of the corresponding Gini coefficients. 6.2.3 Evaluation Based on Theil Index According to the Theil index based on geographic distribution, the overall Theil index for registered dental chairs was 0.7128, which was higher than that for community oral health institutions (0.4819). Specifically, the Theil index for dental chairs was 0.3809 in suburban districts and only 0.0359 in urban districts (see Table 5). At the population level, the overall Theil indices for community oral health institutions and registered dental chairs were 0.0444 and 0.0573, respectively, both of which were much lower than their respective values in the geographic dimension (see Table 5). Decomposition analysis of the Theil index showed that the index for the geographic distribution of dental chairs reached 0.7128, representing the highest value among all measured indices (see Table 6). The contribution to overall resource distribution was also significantly higher in suburban districts than in urban districts. For the geographic distribution of dental chairs, the contribution value was 0.0734 in urban districts and 0.9266 in suburban districts (see Table 7). Table 5. Theil Indices of Community Oral Healthcare Resources Distribution in Shanghai by Geographic Area and Population Served Theil Indices for the Distribution of Community Dental Clinics Registered Dental Chairs Based on Geographic Area and Population Served Urban Suburban Total Urban Suburban Total Based on Geographic Area 0.43 0.5059 0.4819 0.0359 0.3809 0.7128 Based on Population Served 0.0733 0.0272 0.0444 0.0197 0.0525 0.0573 Table 6. Decomposition of the Theil Index (Total Theil Index = Within-Region Inequality + Between-Region Inequality) TWR TBR Theil Index (L) Population–Clinic Distribution 0.0443 0.0000 0.0444 Geographic–Clinic Distribution 0.4734 0.0085 0.4819 Population–Chair Distribution 0.0414 0.0159 0.0573 Geographic–Chair Distribution 0.3556 0.3572 0.7128 Table 7. Regional Contributions to Inequality in Resource Distribution Urban Suburban Population–Clinic Distribution 0.3726 0.6274 Geographic–Clinic Distribution 0.4286 0.5714 Population–Chair Distribution 0.3369 0.6631 Geographic–Chair Distribution 0.0734 0.9266 6.3 Association Between Community Oral Health Resources and Residents’ Health Status 6.3.1 Data Distribution and Normality Testing Normality testing indicated that the mean number of decayed, missing, and filled teeth (DMFT) for 5-year-olds, the caries prevalence among 12-year-olds, the periodontal health rate among 18-year-olds, and relevant oral healthcare resource indicators (such as the dental manpower index (21) and dentist density) all conformed to a normal distribution, confirming the suitability of the data for subsequent Pearson correlation analysis. Pearson correlation analysis was performed to explore the associations between community oral health resource indicators and residents’ oral health outcomes (including caries prevalence and periodontal health rate). The analysis yielded several notable findings. A significant positive correlation was observed between the dental manpower index and residents’ periodontal health rate (r = 0.881, p < 0.05). Dentist density also demonstrated a significant positive correlation with periodontal health rate (r = 0.870, p < 0.05). Other resource indicators showed similar trends in their associations with oral health outcomes, although some did not reach statistical significance. For instance, the proportion of dentists with intermediate or senior professional titles was negatively correlated with caries prevalence among 12-year-old children (r = –0.684), but this association was not statistically significant (p > 0.05). The proportion of staff with a bachelor’s degree or higher showed a weak, non-significant correlation with residents’ overall oral health outcomes. Table 8. Pearson Correlation Between Community Oral Health Resource Indicators and Residents’ Oral Health Outcomes 5-year-olds Mean dmft 5-year-olds Caries Prevalence 12-year-olds mean DMFT 12-year-olds Caries Prevalence 18-year-olds mean DMFT 18-year-olds Caries Prevalence 18-year-olds' Periodontal Health Rate Dental Workforce Index (×10⁵ people) r -0.049 0.167 -0.180 -0.061 -0.313 -0.426 0.881* p-value 0.927 0.752 0.733 0.908 0.546 0.400 0.020 Dentist-to-Population Ratio (×10⁵ people) r 0.050 0.320 -0.394 -0.299 -0.317 -0.221 0.870* p-value 0.925 0.537 0.439 0.565 0.541 0.674 0.024 Proportion of Staff Involved in Oral Health Prevention r -0.336 -0.515 0.669 0.715 0.006 -0.584 -0.061 p-value 0.515 0.296 0.147 0.110 0.991 0.223 0.909 Proportion of Staff with Bachelor’s Degree or Above r 0.342 0.567 -0.446 -0.315 -0.109 0.031 0.690 p-value 0.507 0.240 0.375 0.543 0.837 0.953 0.129 Proportion of Senior-Level Dental Professionals r -0.465 -0.684 0.635 0.563 0.015 -0.372 -0.380 p-value 0.353 0.134 0.176 0.245 0.978 0.468 0.457 * p <0.05 ** p <0.01 Discussion Drawing on field investigations of 249 community health service centers in Shanghai and data from the 2021 oral health epidemiological survey, this study systematically analyzed the current status of community oral healthcare resources allocation across multiple dimensions, including human resources, equipment configuration, regional disparities, equity assessment, and health outcomes. By integrating multisource data and applying multidimensional quantitative methods, the study identified the principal characteristics and challenges of Shanghai’s community dental care system in terms of resource structure, service positioning, and equity. The discussion addresses workforce structure, resource distribution patterns, equity evaluation, and associations with health outcomes, and presents recommendations for optimization within the framework of current health policy. 1. Characteristics and Implications of the Community Dental Workforce Structure In terms of human resources, the community dental workforce in Shanghai is predominantly female (78.2%) and primarily consists of young and middle-aged professionals (63.9% aged 44 years or younger). Staff with a bachelor’s degree or higher account for 76.6% of the team, whereas only 4.2% hold senior professional titles. This composition reflects the high overall educational attainment and younger workforce profile, aligning with national policies on hierarchical healthcare and strengthening primary care. The relatively low proportion of senior professionals is unlikely to compromise routine service delivery at the community level; on the contrary, it may accelerate the advancement of younger practitioners and invigorate primary care teams. However, these findings also underscore the need for stronger collaboration and support from tertiary care institutions, particularly in the referral of complex cases and in the continuing education and skill development of community dental staff, to enhance the overall capacity of regional health services. 2. Current Status of Hardware Resource Allocation and Service Utilization Regarding equipment and facilities, suburban community health centers have a clear advantage in allocating dental hardware resources. The number of independent dental departments, registered dental chairs, and the total clinical space are all higher in suburban areas compared to central districts. Notably, the configuration of high-end equipment—including dental CT scanners, implant systems, and laser therapy units—is also greater in suburban districts, reflecting the positive outcomes of resource “downshifting” policies. This distribution pattern indicates that, alongside urban expansion and population migration, demand for dental services in suburban areas has risen substantially, and the capacity of primary care has been effectively enhanced. This trend is consistent with the growth in suburban populations and the expanding demand for oral health services, thereby improving both accessibility and equity at the primary care level. However, an increase in equipment quantity does not automatically translate into improved service capacity. Effective utilization of advanced equipment requires commensurate technical expertise among healthcare personnel and standardized management; otherwise, resources may be underutilized. Moving forward, it is essential to strengthen the training and technical support for primary care staff, optimize regional collaboration, and further enhance the overall effectiveness and quality of community oral healthcare services. 3. Multidimensional Equity Assessment and Distribution Characteristics In this study, the equity of community oral healthcare resources allocation in Shanghai was evaluated using three internationally recognized methods: the Lorenz curve, Gini coefficient, and Theil index, each offering distinct perspectives that complement one another in forming a robust analytic framework. Lorenz curve analysis revealed marked deviation from the line of absolute equality for the geographic distribution of dental department clinic space, the number of hospitals with independent dental departments, and the number of registered dental chairs, indicating significant spatial inequity in resource allocation. In contrast, the Lorenz curves for the population and economic dimensions were comparatively flatter, indicating a more balanced allocation of resources across these dimensions. These trends are closely aligned with the quantitative results of the Gini coefficient. The Gini coefficient, as a core indicator of overall equity, further quantifies multidimensional distribution characteristics. For hospitals with independent dental departments, the Gini coefficient was 0.151 (geographic), 0.357 (population), and 0.362 (GDP); for registered dental chairs, 0.356 (geographic), 0.420 (population), and 0.400 (GDP); and for dental department clinic space, 0.371 (geographic), 0.448 (population), and 0.430 (GDP). According to international grading standards, the geographic Gini coefficients, while not reaching the critical alert threshold, still warrant attention regarding spatial inequity. Meanwhile, coefficients for the population and economic dimensions fell within the “moderately equitable” to “alert” ranges, indicating a clear tendency for resources to cluster in densely populated and economically developed areas. The introduction of the Theil index allowed for deeper analysis of the sources of inequity. The Theil index for the geographic distribution of registered dental chairs reached 0.7128, substantially higher than that for community oral healthcare institutions (0.4819), indicating that the most significant disparities exist at the spatial level. Decomposition further demonstrated that suburban districts accounted for 0.9266 of the geographic disparity in dental chair distribution, far surpassing the contribution of central districts, and suggesting that overall inequity is mainly attributable to disparities within suburban areas. Conversely, Theil indices for the population dimension (0.0573 for registered dental chairs and 0.0444 for healthcare institutions) were significantly lower, reflecting adjustments in resource allocation to meet population needs. In summary, the results from all three methods were highly consistent, revealing substantial spatial inequity, resource concentration in population and economic centers, and significant intra-suburban disparities in the distribution of Shanghai’s community oral healthcare resources. Although notable spatial inequity exists, the levels of equity in the population and economic dimensions are comparatively better, reflecting current strategies that prioritize the needs of the actual population and economic development, consistent with people-centered allocation principles. Nevertheless, spatial disparities—especially in remote areas—should not be ignored. Future strategies should not only strengthen equity across population and economic dimensions but also enhance spatial accessibility, ultimately achieving genuine equity and accessibility of dental healthcare services. 4. Deviation in Community Health Center Positioning and Functional Reflection The core mandate of community health centers (CHCs) is to provide essential medical care, preventive health services, and health management, rather than to deliver complex specialty treatments( 22 ). However, this study found that some community dental departments—across both central and suburban districts—have inappropriately invested in high-end equipment (such as dental CT scanners and operating microscopes) and are performing advanced procedures, including dental implants and microscopic endodontic therapy. This has resulted in redundant infrastructure and undermined core primary care functions. Such a top-heavy approach has, in effect, transformed CHCs into “mini-specialty hospitals,” blurring their strategic role, diverting resources from public health programs (such as fluoride varnish for children and oral health screening for older adults), and weakening public trust in primary care. These dynamics may further exacerbate patient overflow to tertiary care facilities. 5. Association Between Resource Allocation and Health Outcomes This study systematically assessed the association between the allocation of community oral healthcare resources and residents’ oral health outcomes using Pearson correlation analysis. The analysis revealed a highly significant positive correlation between the dental manpower index and the periodontal health rate among individuals aged 18 years and older (r = 0.881, p = 0.020), as well as a strong positive correlation between dentist density and the periodontal health rate (r = 0.870, p = 0.024). These findings underscore the critical importance of adequately and appropriately distributing dental professional resources at the community level to improve periodontal health and achieve health equity. This evidence aligns with both domestic and international literature, further emphasizing the pivotal role of accessibility to oral healthcare resources in determining health outcomes. Additionally, specific indicators—such as the proportion of dentists with intermediate or senior professional titles—were negatively correlated with caries prevalence among 12-year-old children (r = − 0.684). However, this relationship did not reach statistical significance. This may suggest the potential value of highly qualified dentists in the prevention and management of pediatric caries. Notably, the proportion of staff with a bachelor’s degree or higher exhibited only a weak and non-significant association with oral health outcomes, suggesting that improvements in residents’ oral health depend not solely on educational attainment or professional rank, but instead on the overall capacity and effectiveness of the dental care team and service delivery models. 6. Policy Recommendations: Optimizing Hierarchical Healthcare and Resource Integration The core functions of community health should be prioritized. At the community level, the integration of preventive care and basic clinical services should be emphasized, with continuous efforts to expand the coverage and improve the quality of public health initiatives. Rational allocation of equipment and workforce based on primary care needs is essential to prevent redundant construction and overinvestment, thereby ensuring that community health centers are equipped to meet fundamental oral health needs. Enhancement of the hierarchical healthcare delivery system is also necessary. Leveraging Shanghai’s experience with the “family doctor system,” a multi-tiered oral health collaboration network should be established within the city. At the community level, primary care providers should focus on initial screening, early intervention for common and frequently occurring oral diseases, and promoting prevention-oriented models through health education. Secondary and tertiary care institutions should undertake more complex clinical responsibilities, providing technical support and expert consultation for challenging cases. Bidirectional referral pathways and remote collaboration should be developed to optimize resource allocation and reduce unnecessary duplication of services. Furthermore, greater integration of public health and clinical services is warranted. This should be achieved through comprehensive community health planning and systematic training and professional support for primary care practitioners, with particular emphasis on the oral health needs of key populations such as children and the elderly. Dental professionals should be encouraged to participate in regular on-site outreach and capacity-building activities in the community, thereby strengthening cooperation across the continuum of prevention, diagnosis, and rehabilitation, and ultimately enhancing both the accessibility and quality of primary oral healthcare services, thereby achieving equity and efficiency in community oral healthcare. Conclusion This study systematically evaluated the structure, equity, and health impact of the allocation of community oral healthcare resources in Shanghai. The results demonstrate that the current community dental workforce is relatively young and well-educated, and that the redistribution of hardware resources to the primary care level has progressed positively, with suburban districts now possessing a dominant share of dental infrastructure. Nevertheless, marked spatial inequities persist, especially in the geographic dimension, as revealed by the Lorenz curve, Gini coefficient, and Theil index. In contrast, equity in the population and economic dimensions is comparatively better, suggesting that resource allocation is more aligned with areas of population and economic concentration. Further analysis indicated that sufficient and appropriately distributed dental professional resources are strongly associated with improvements in residents’ periodontal health, whereas simply increasing the proportion of highly educated or senior-ranked professionals exerts only a limited effect on health outcomes. In particular, community dental departments have seen an excessive allocation of high-end equipment, leading to a drift from their fundamental mission of providing basic care and prevention. This underscores the urgent need for policy realignment and structural optimization. In conclusion, optimizing community oral healthcare resources allocation in Shanghai requires continued enhancement of the hierarchical healthcare delivery system, rational planning and allocation of workforce and equipment, prioritization of public health functions at the primary care level, greater regional collaboration and talent development, and improvement of the homogeneity and equitable accessibility of oral healthcare services. Looking ahead, resource planning should be increasingly driven by actual health needs, with an emphasis on quality over quantity, to support sustained improvements in residents’ oral health and contribute to the realization of the “Healthy China” strategic objectives. Declarations Human Ethics and consent to participate This study was approved by the Ethics Committee of the China Oral Health Foundation (COHF), with approval number COHF#2021-001 and an approval date of March 31, 2021. Participation was voluntary, and written informed consent was obtained from all participants. For child participants, consent was provided by their parents or legal guardians. Clinical trial number Not applicable. Consent for publication Not applicable. This manuscript does not contain any person’s data. Availability of data and materials Due to participant privacy, the datasets used and/or analyzed during the current study are not publicly available but can be obtained from the corresponding author upon reasonable request. Competing interests All authors declare that they have no competing interests. Author contribution statement All authors made substantial contributions to the conception and design of the study. Dongxin Da, Junjie Xie, Shuran Yao, Jin Yu, Yiwei Jiang, Huning Wang were involved in data collection. Wenjie Song, Xiaoli Zeng, Hao Zhang, and Ying Zhang were involved in data analysis and interpretation. Wenjie Song, Xiaoli Zeng drafted the manuscript. Jing Zhu, Ying Zhang revised it critically for important intellectual content. Jing Zhu, Ying Zhang approved the final version to be published. Funding This study was funded by the Key Discipline Program of the Sixth Round of the Three-Year Public Health Action Plan (2023-2025) of Shanghai (GWVI-11.1-31 and GWVI-11.1-16) and the National Oral Health Surveillance for Key Populations in 2021 [2020 (609)]. Acknowledgements We want to thank the staff of various district dental clinics in Shanghai for their valuable assistance with data collection during the project. We are also grateful to the funding bodies that supported this study: the Key Discipline Program of the Sixth Round of the Three-Year Public Health Action Plan (2023–2025) of Shanghai (GWVI-11.1-31 and GWVI-11.1-16), and the National Oral Health Surveillance for Key Populations in 2021 [2020 (609)]. Authors information Wenjie Song * ab Xiaoli Zeng * ab Hao Zhang ab Dongxin Da ab Junjie Xie ab Shuran Yao ab Jin Yu ab Yiwei Jiang ab Huning Wang ab Corresponding authors Ying Zhang ab ( [email protected] , (+86)13917555798, Shanghai Stomatological Hospital) Jing Zhu ab (primary, [email protected] , Shanghai Stomatological Hospital) Institution ： a: Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China b: Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China References Spanemberg JC, Cardoso JA, Slob E, López-López J. Quality of life related to oral health and its impact in adults. J Stomatol Oral Maxillofac Surg. 2019;120(3):234–9. Chen MS, Hunter P. Oral health and quality of life in New Zealand: a social perspective. Soc Sci Med. 1996;43(8):1213–22. Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–70. Petersen PE, The World Oral Health Report. 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31 Suppl 1:3–23. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The Global Burden of Oral Diseases and Risks to Oral Health. Bull World Health Organ. 2005;83(9):661–9. Fisher J, Selikowitz HS, Mathur M, Varenne B. Strengthening oral health for universal health coverage. Lancet. 2018;392(10151):899–901. Ogunbodede EO, Kida IA, Madjapa HS, Amedari M, Ehizele A, Mutave R, et al. Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region. Adv Dent Res. 2015;27(1):18–25. Xie X, Liu P, Zheng Y, Zhou W, Zou J, Wang X, et al. Equity of health resource distribution in China during 2009–15: an analysis of cross-sectional nationwide data. Lancet. 2017;390:S6. Liu Q, Wang B, Kong Y, Cheng KK. China's primary health-care reform. Lancet. 2011;377(9783):2064–6. Dong E, Xu J, Sun X, Xu T, Zhang L, Wang T. Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China. Archives Public Health. 2021;79(1):78. Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, et al. The Tsinghua–Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet. 2018;391(10135):2140–84. Dong E, Liu S, Chen M, Wang H, Chen L-W, Xu T et al. Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China. BMJ Open. 2020;10. Li Y, Yu J, Jin L, Zhu Z, editors. The study on the equity of medical and health resources distribution in Shanghai. 2022 10th International Conference on Orange Technology (ICOT); 2022 10–11 Nov. 2022. Harford J. Population ageing and dental care. Community Dent Oral Epidemiol. 2009;37(2):97–103. Khoury Z, Ferguson A, Price J, Sultan A, Wang R. Responsible artificial intelligence for addressing equity in oral healthcare. Front Oral Health. 2024;5. The Fourth National Oral Health Epidemiological Survey Technology Group CSA. Work manual of the fourth national oral health epidemiological survey (2015–2018). Beijing: Chinese Stomatological Association; 2015. p. 8. Contract No. Lorenz MO. Methods of measuring the concentration of wealth. Publications Am Stat Association. 1905;9(70):209–19. Zheng Y, Yan L, Hua C, Liang X, Yang Z. Analysis of dental clinic and dental chair distribution in Sichuan. Hua Xi Kou Qiang Yi Xue Za Zhi. 2023;41(3):333–40. Theil H. Economics and information theory. Econ J. 1967;79(315):601–2. SPSSAU Project Team. SPSSAU (Version 25.0) [Online Application Software]. Chinese Academy of Sciences. 2025. https://www.spssau.com . Accessed 9 May 2025. LI Gang NZ-z. Designing Dental Manpower Index to Evaluate Dental Manpower Resources. West China J Stomatology. 2004;22(03):255–8. China NHCotPsRo. Guidelines for the assessment of service capacity of community health service centers (2019 edition). Beijing: National Health Commission; 2019. p. 2. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 Feb, 2026 Editor invited by journal 20 Jan, 2026 Reviewers invited by journal 16 Jul, 2025 Editor assigned by journal 07 Jul, 2025 Submission checks completed at journal 07 Jul, 2025 First submitted to journal 01 Jul, 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. 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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-7019977","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486516045,"identity":"0b792ed8-2158-4a3a-a904-88234d76ee1d","order_by":0,"name":"Wenjie Song","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Wenjie","middleName":"","lastName":"Song","suffix":""},{"id":486516046,"identity":"875a5f92-648e-4f87-9805-5f84d46ec1d7","order_by":1,"name":"Xiaoli Zeng","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Zeng","suffix":""},{"id":486516049,"identity":"f3821aaa-3ba3-45bf-9fb8-760fb8ed640c","order_by":2,"name":"Hao Zhang","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Zhang","suffix":""},{"id":486516052,"identity":"65abbbaf-dd85-45b8-9af7-57fd57ab96fc","order_by":3,"name":"Dongxin Da","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Dongxin","middleName":"","lastName":"Da","suffix":""},{"id":486516053,"identity":"6dde5425-da88-4b54-bff4-f9e0f9ef5500","order_by":4,"name":"Junjie Xie","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Junjie","middleName":"","lastName":"Xie","suffix":""},{"id":486516057,"identity":"6aabe12d-95a0-465b-a36f-e005167edbdf","order_by":5,"name":"Shuran Yao","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Shuran","middleName":"","lastName":"Yao","suffix":""},{"id":486516061,"identity":"9801a2bf-0996-4178-beb6-726c86f2a284","order_by":6,"name":"Jin Yu","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Yu","suffix":""},{"id":486516067,"identity":"c24a560f-2bae-471b-98f4-71a6f1177d10","order_by":7,"name":"Yiwei Jiang","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yiwei","middleName":"","lastName":"Jiang","suffix":""},{"id":486516068,"identity":"94c9c1fb-4a2e-49fa-bfa1-1c0bccf5a701","order_by":8,"name":"Huning Wang","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Huning","middleName":"","lastName":"Wang","suffix":""},{"id":486516070,"identity":"6c715a5a-dfa4-45a4-9ebe-701afa49d362","order_by":9,"name":"Ying Zhang","email":"","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Zhang","suffix":""},{"id":486516071,"identity":"e9b32fbd-ed2e-4784-af84-749cb583c94b","order_by":10,"name":"Jing Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIie3PsQqCQBzH8b8cnMuR6wWir3DtQa/iETQVODqYJMY5VHtQD9EUjkWgy7U36iO01ZZWUJM6Bt13/n3g/wdQqX4xCsAcAIKRFuaO57cnZkePIpbLtB2p6lskE91ijpqFvVkyt0imBFMuPD7DYMQLp5ZoW8kYl9mTXHhiApXnXS1BdFwSkb6JxMDopJ7gb+JygZoJeRGfYHIU0IpQOnJLciBYDyPqyJQ0/mKvh/veXQQDO9KL683zLSNe1ZPqHQZw+lzaNK9COUDQZqhSqVT/2gPUF0VZqqyfFQAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2025-07-01 11:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7019977/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7019977/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87186855,"identity":"7040a5f9-eb21-442a-b496-0a2cb011fc46","added_by":"auto","created_at":"2025-07-21 10:33:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264272,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLorenz Curves of Cumulative Distribution of Dental Department Utilization Area by Geography, Population, and Economic Output in Shanghai\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7019977/v1/ca4b85fbf4c6cb24ea807d36.jpg"},{"id":87186419,"identity":"da86ce36-68f2-46a7-bd31-dcd0cfc47643","added_by":"auto","created_at":"2025-07-21 10:25:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":275999,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLorenz Curves of Cumulative Distribution of Community Hospitals with Independent Dental Departments by Geography, Population, and Economic Output in Shanghai\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7019977/v1/8a37c99dfd733d017b4a6824.jpg"},{"id":87186425,"identity":"0cbf2d8b-0512-41ff-b542-3b3b3af37b30","added_by":"auto","created_at":"2025-07-21 10:25:36","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":301286,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLorenz Curves Depicting the Cumulative Distribution of Registered Dental Chairs Across Shanghai Districts by Geographic Area, Population Size, and Economic Output\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7019977/v1/074e16f963d597681a3f4cb5.jpg"},{"id":87186420,"identity":"5e6bec20-a5eb-4fca-ba1e-63dc96af54f7","added_by":"auto","created_at":"2025-07-21 10:25:36","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":151246,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePearson Correlation Heatmap\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7019977/v1/a46125c3df9b9b32041c0afe.jpg"},{"id":87187476,"identity":"4850a16a-3630-4786-92f7-7ecc6efd9d13","added_by":"auto","created_at":"2025-07-21 10:41:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2825196,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7019977/v1/9eb28da5-ad37-4604-9c92-106e86cffd00.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spatial Distribution of Community Oral Healthcare Resources and Their Association with Oral Health Status in Shanghai, China","fulltext":[{"header":"Background","content":"\u003cp\u003eOral health is a crucial component of overall health, significantly affecting individuals' quality of life, work efficiency, and social interactions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The World Health Organization (WHO) has explicitly included oral health as a key category in the Global Burden of Disease Report and advocates for health equity through optimized resource allocation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, a marked global disparity persists in the distribution of oral healthcare resources, particularly between economically underdeveloped and developed regions, which limits access to essential oral healthcare services for vulnerable populations (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough China\u0026rsquo;s overall healthcare resources are relatively balanced, wealthier regions receive a larger share of human and financial investments. Meanwhile, hospitals with sufficient resources are predominantly concentrated in economically developed areas, whereas grassroots healthcare institutions in impoverished regions often face resource shortages. This imbalance in distribution may further widen disparities in healthcare utilization between affluent and disadvantaged populations (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Since the launch of China\u0026rsquo;s new round of healthcare reform in 2009, multiple measures have been implemented to optimize resource allocation and enhance healthcare equity, including expanding urban-rural health insurance coverage and strengthening primary healthcare networks to reduce regional and urban-rural disparities (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Specifically, the Healthy China 2030 Plan emphasizes prioritizing the allocation of medical resources to primary care to improve overall public health (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs a major economic and social hub in China, Shanghai's community healthcare system plays a critical role in providing primary healthcare services to all residents. Recent statistical data indicate a significant expansion in the total number of community hospitals; however, disparities in resource distribution remain (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). For example, suburban districts have gradually improved their allocation of basic oral healthcare resources. At the same time, central urban areas concentrate more advanced diagnostic equipment and high-end medical resources to cater to the diverse needs of regional populations (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Furthermore, with population aging and rising oral health demands, the supply-demand gap in community healthcare resources is becoming increasingly prominent (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOptimizing the distribution of healthcare resources can not only improve equity and accessibility but also reduce the burden of disease and enhance population health indicators (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, research on the equity of community oral healthcare resource distribution in Shanghai and its association with residents\u0026rsquo; oral health outcomes remains limited. This study aims to fill this gap by quantitatively analyzing the current status and equity of oral healthcare resource allocation and exploring its potential association with residents\u0026rsquo; health outcomes, providing scientific evidence for policy formulation.\u003c/p\u003e"},{"header":"Research Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e5.1. Data Sources\u003c/h2\u003e\u003cp\u003eThe data of this study were primarily obtained from the following three sources:\u003c/p\u003e\u003cp\u003eHealthcare Workforce and Facility Survey: The survey covered all 16 administrative districts in Shanghai, comprising seven urban districts (Huangpu, Xuhui, Changning, Jing\u0026rsquo;an, Putuo, Hongkou, and Yangpu) and nine suburban districts (Baoshan, Jiading, Jinshan, Minhang, Songjiang, Qingpu, Fengxian, Pudong New Area, and Chongming), and included a total of 249 community health service centers surveyed.\u003c/p\u003e\u003cp\u003eOral Health Survey: Data were derived from the 2021 China Nutrition and Chronic Disease Surveillance \u0026ndash; Shanghai Oral Health Survey. Using a cluster-sampling technique, six districts (Hongkou, Jing\u0026rsquo;an, Minhang, Pudong New District, Putuo, and Xuhui) were randomly chosen from the city\u0026rsquo;s 16 administrative districts. Within each selected district, four kindergartens, three middle schools, and three village (residents) committees served as sampling clusters. From each kindergarten, 50 five-year-old children were randomly selected (totaling 1,200 children); from each middle school, 50 twelve-year-old students were randomly selected (totaling 900 adolescents); and from each village (residents) committee, 100 adults across two age cohorts (35\u0026ndash;44 and 65\u0026ndash;74 years) were randomly selected (totaling 1,800 adults). Written informed consent was obtained from all participants or their legal guardians.\u003c/p\u003e\u003cp\u003ePublic Statistical Data: Data on geographic area, resident population, and Gross Domestic Produgeographic area, resident population, and Gross Domestic Product (GDP) for each administrative district were obtained from the Shanghai Statistical Yearbook 2023 and the 2023 National Economic and Social Development Statistical Bulletins of individual districts.\u003c/p\u003e\u003cp\u003eThe survey instruments for the healthcare workforce and oral health examination data collection were adapted from the National Oral Health Epidemiological Survey conducted in China in 2015(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e5.2. Data Collection and Quality Control\u003c/h2\u003e\u003cp\u003eBefore the oral health survey, all staff underwent centralized training, and inter-examiner reliability was assessed during the survey process (Kappa value\u0026thinsp;\u0026gt;\u0026thinsp;0.8). The examination was conducted using a Community Periodontal Index (CPI) probe, a flat mouth mirror, and portable lighting, which combined visual inspection and probing under artificial light.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e5.3. Data Analysis Methods\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e5.3.1. Resource Distribution Assessment:\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eLorenz Curve\u003c/strong\u003e\u003cp\u003eThe Lorenz curve, introduced by American statistician Max O. Lorenz in 1905, is a graphical representation used to illustrate the distribution of resources or income within a population (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The x-axis represents the cumulative proportion of the population, while the y-axis represents the cumulative proportion of resources. When resources are perfectly equally distributed, the curve follows the diagonal line of equality. The greater the deviation from this line, the higher the level of inequality in resource distribution.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eIn this study, Lorenz curves were plotted to analyze the equity of oral healthcare resource distribution in Shanghai, including the number of community hospitals with independent dental departments and the number of registered dental chairs. The x-axis represents the cumulative percentage of geographic area, population, and economic output (GDP), while the y-axis represents the corresponding cumulative percentage of oral healthcare resources.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGini Coefficient\u003c/b\u003e: The Gini coefficient, derived from the Lorenz curve, provides a quantitative measure of the equity in resource distribution. Its values range from 0 to 1, where 0 indicates perfect equality and 1 indicates extreme inequality. A Theil index value is generally interpreted as follows: 0\u0026ndash;0.2 indicates a highly equitable state; 0.2\u0026ndash;0.3, a relatively equitable state; 0.3\u0026ndash;0.4, a moderately equitable state; values above 0.4 represent an alert state; 0.5\u0026ndash;0.6, an inequitable state; and values above 0.6 indicate a highly inequitable state(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In this study, the Gini coefficient was calculated based on geographic area, population distribution, and economic output, assessing disparities in the number of community hospitals with independent dental departments and the number of registered dental chairs. The combination of the Lorenz curve and the Gini coefficient offers a clear and accurate analytical framework for evaluating the distribution of oral healthcare resources across geographic, demographic, and economic dimensions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheil Index\u003c/b\u003e: The Theil index, initially proposed by econometrician Henri Theil from Erasmus University Rotterdam (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), has also been widely used in studies assessing the equity of healthcare resource distribution. To further analyze the equity of oral healthcare resource distribution in Shanghai\u0026rsquo;s community healthcare system, this study applies information entropy theory to compute the resource distribution disparity index from two perspectives: geographic distribution and service population distribution. The analysis covers three levels: citywide distribution, intra-urban and intra-suburban disparities, and inter-district disparities, while also evaluating the extent to which disparities between urban and suburban districts contribute to overall inequality.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e5.3.2 Health Data Analysis\u003c/h2\u003e\u003cp\u003eData entry was performed using EpiData 3.2, and statistical analysis was conducted using SPSSAU. (Version 25.0) [Online Application Software] (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The analysis included the frequency and proportion of oral public health workforce and hardware equipment, as well as the mean and standard deviation of caries prevalence (DMFT index) and periodontal health rate among 5-year-old and 12-year-old children and adults in urban and suburban areas. Key indicators analyzed included: Dentist-to-population ratio (number of dentists per 100,000 people), Proportion of healthcare workers engaged in dental prevention programs, Percentage of healthcare workers with a bachelor's degree or higher, Proportion of senior and intermediate-level dentists. Additionally, the Dental Manpower Index (DMI) was introduced to quantify the allocation of human resources. The index was calculated as: DMI = (1 \u0026times; Dentists\u0026thinsp;+\u0026thinsp;1 \u0026times; Oral Physicians\u0026thinsp;+\u0026thinsp;0.5 \u0026times; Dental Assistants\u0026thinsp;+\u0026thinsp;0.25 \u0026times; Dental Hygienists\u0026thinsp;+\u0026thinsp;0.5 \u0026times; Dental Technicians + \u0026hellip;\u0026hellip;)\u0026thinsp;\u0026divide;\u0026thinsp;Total Population of the Country or Region (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Pearson correlation analysis was used to examine the relationship between resource allocation and oral health indicators, including caries prevalence and periodontal health rates. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Research Results","content":"\u003ch2\u003e6.1. Current Status of Community Oral Healthcare Resources\u003c/h2\u003e\n\u003ch3 id=\"_Toc25942\"\u003e6.1.1. Structure of Healthcare Workforce\u003c/h3\u003e\n\u003cp\u003eThe oral preventive care teams in community hospitals across Shanghai display distinct features in terms of human resources. The teams are predominantly composed of licensed practitioners. Females constitute 78.2% of the workforce, substantially exceeding the proportion of males (21.8%). In terms of age distribution, staff aged 44 years and younger account for 63.9%, representing the core workforce; those aged 45\u0026ndash;59 years comprise 33.7%, while those aged 60 years or above make up only 2.4% (see Table 1).\u003c/p\u003e\n\u003cp\u003eRegarding educational background, 76.6% of staff hold a bachelor\u0026rsquo;s degree or higher, with 74.5% holding a bachelor\u0026rsquo;s degree and 2.1% possessing a postgraduate degree. The professional title structure indicates a significant shortage of senior-level professionals, with only 4.2% holding senior professional titles and 37.3% holding intermediate titles.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Structure of Health Professionals Involved in Oral Health Prevention in Shanghai Community Hospitals, 2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eProportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026le; 44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e63.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e45-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e60-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eGrouping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePublic Health Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eNursing Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eDentistry Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eOutpatient Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSpecialty Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eEducational Background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSecondary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eAssociate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eAbove a bachelor\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eProfessional Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eDental Technicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eWork Scope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eDental Prevention Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eBoth Areas Involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eDental Outpatient Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePost-Tax Income\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(in thousand CNY)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eX＜10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e10\u0026le;X＜15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e15\u0026le;X＜20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e20\u0026le;X＜25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e25\u0026le;X＜30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eX\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eAdministrative Region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eCentral Urban Area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSuburban Area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e68.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eProfessional Title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSenior Physicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eIntermediate Physicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e37.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eJunior Physicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePhysicians without Title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eIntermediate Technicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eJunior Technicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSenior Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eIntermediate Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eJunior Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3 id=\"_Toc13539\"\u003e6.1.2. Distribution of Equipment and Facilities\u003c/h3\u003e\n\u003cp\u003eThe overall configuration of oral healthcare equipment in Shanghai\u0026rsquo;s community hospitals is relatively advanced; however, there are significant differences between urban and suburban areas. The number of registered dental chairs in suburban districts is 433, accounting for 66.02%, while in central urban districts, the number is 233, representing 33.98% (see Table 2). Suburban districts not only account for a larger share of basic equipment such as dental chairs and ultrasonic scalers but also significantly surpass urban districts in the availability of high-end devices, including implant systems, microscopes, and laser therapy units (see Table 3). In terms of clinic space utilization, suburban districts have a total area of 14,589.71 square meters (57.68%), while central urban districts have a total area of 10,693.31 square meters (42.32%) (see Table 2).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"579\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"14\" style=\"width: 579px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2: Licensing and Facility Area of Community Hospitals in Shanghai (2023)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 83px;\"\u003e\n \u003cp\u003eIndependent Dental Departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 112px;\"\u003e\n \u003cp\u003eRegistered Dental Chairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003eRestricted Technology Licenses (e.g., Dental Implantation Accreditation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 130px;\"\u003e\n \u003cp\u003eClinic Area in Community Hospitals (㎡)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eProportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eProportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eProportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eS/m\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003eProportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e34.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e33.98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e34.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e10693.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e42.32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e65.42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e66.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e65.52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e14589.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e57.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"535\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Oral Healthcare Equipment in Shanghai\u0026rsquo;s Community Hospitals (2023)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eCentral Urban Area (N/%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eSuburban Area (N/%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"24\" style=\"width: 18px;\"\u003e\n \u003cp\u003eDental Equipment Configuration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eDental CT Scanner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e6/35.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11/64.71%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eX-ray Panoramic Machine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e23/31.13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e51/68.87%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eX-ray Intraoral Machine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e60/35.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e107/64.08%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eImplant System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2/15.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11/84.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eUltrasonic Bone Scalpel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7/46.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e8/53.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMicroscope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1/33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2/66.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eThermoforming Machine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e13/35.14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e24/64.86%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eRotary Endodontic Treatment Device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e47/33.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e93/66.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eRoot Canal Length Measuring Instrument\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e84/35.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e153/64.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003ePulp Vitality Tester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e21/36.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e36/63.16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eUltrasonic Scaler\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e150/37.04%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e255/62.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eLaser Therapy Device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0/0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5/100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eIntraoral Scanner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1/33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2/66.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eElectrosurgical Knife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e11/40.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e16/59.26%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eHead-mounted Magnifying Glass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e8/50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e8/50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eThermoplastic Gutta-Percha Obturation Device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e14/40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e21/60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eComprehensive Treatment Chair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e205/33.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e406/66.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eLight-curing Lamp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e159/31.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e347/68.57%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003ePortable Dental Chair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e40/20.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e157/79.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eSmall Mobile Multifunctional Equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e27/17.65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e126/82.35%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eAmalgamator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e76/36.19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e134/63.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eVacuum Steam Sterilizer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e96/35.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e176/64.71%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eEnzyme Washer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e74/33.94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e144/66.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMobile UV Disinfection Device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e60/24.79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e182/75.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e6.2 Equity Assessment of Community Oral Healthcare Resource Distribution\u003c/h2\u003e\n\u003cp\u003eThis study employed the Gini coefficient, Lorenz curve, and Theil index to comprehensively evaluate the equity of community oral healthcare resource distribution in Shanghai. The assessment focused on three key dimensions: the number of community hospitals with independent dental departments, the number of registered dental chairs, and the usable area of dental departments. The results reveal disparities and characteristics of equity in resource distribution across geographic, population, and economic dimensions.\u003c/p\u003e\n\u003ch3 id=\"_Toc25986\"\u003e6.2.1 Assessment Based on the Gini Coefficient\u003c/h3\u003e\n\u003cp\u003eThe Gini coefficient, as a key quantitative metric for evaluating the equity of resource allocation, highlights the distributional characteristics of different resources across geographic, demographic, and economic dimensions (see Table 4). In Shanghai, the Gini coefficients for hospitals with stand-alone dental departments were 0.151, 0.357, and 0.362 based on geographic area, population, and economic distribution, respectively. For the number of registered dental chairs, the Gini coefficients were 0.356, 0.420, and 0.400, while those for the allocated clinical space of dental departments were 0.371, 0.448, and 0.430, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Gini Coefficients of Per Capita Community Oral Healthcare Resources in Shanghai by Geographic, Population, and Economic Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eHealthcare Resource\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eGeographic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePopulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eGDP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eCommunity hospitals with independent dental departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eNumber of registered dental chairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eUsable area of dental departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3 id=\"_Toc19086\"\u003e6.2.2 Assessment Based on the Lorenz Curve\u003c/h3\u003e\n\u003cp\u003eThe distribution of clinical space for dental departments by geographic area, population, and economic status is depicted in Figure 1. The distribution of hospitals with stand-alone dental departments, according to these dimensions, is shown in Figure 2. The distribution of registered dental chairs is presented in Figure 3. The distribution patterns were broadly similar across all three indicators and corresponded to the results of the corresponding Gini coefficients.\u003c/p\u003e\n\u003ch3 id=\"_Toc23652\"\u003e6.2.3 Evaluation Based on Theil Index\u003c/h3\u003e\n\u003cp\u003eAccording to the Theil index based on geographic distribution, the overall Theil index for registered dental chairs was 0.7128, which was higher than that for community oral health institutions (0.4819). Specifically, the Theil index for dental chairs was 0.3809 in suburban districts and only 0.0359 in urban districts (see Table 5).\u003c/p\u003e\n\u003cp\u003eAt the population level, the overall Theil indices for community oral health institutions and registered dental chairs were 0.0444 and 0.0573, respectively, both of which were much lower than their respective values in the geographic dimension (see Table 5).\u003c/p\u003e\n\u003cp\u003eDecomposition analysis of the Theil index showed that the index for the geographic distribution of dental chairs reached 0.7128, representing the highest value among all measured indices (see Table 6). The contribution to overall resource distribution was also significantly higher in suburban districts than in urban districts. For the geographic distribution of dental chairs, the contribution value was 0.0734 in urban districts and 0.9266 in suburban districts (see Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Theil Indices of Community Oral Healthcare Resources Distribution in Shanghai by Geographic Area and Population Served\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 42px;\"\u003e\n \u003cp\u003eTheil Indices for the Distribution of Community Dental Clinics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 38px;\"\u003e\n \u003cp\u003eRegistered Dental Chairs\u003cbr\u003e\u0026nbsp;Based on Geographic Area and Population Served\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003eBased on Geographic Area\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.5059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.4819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.3809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.7128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eBased on Population Served\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.0733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.0272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.0444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.0525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.0573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6. Decomposition of the Theil Index (Total Theil Index = Within-Region Inequality + Between-Region Inequality)\u0026emsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTWR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eTBR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eTheil Index (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePopulation\u0026ndash;Clinic Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.0443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.0444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eGeographic\u0026ndash;Clinic Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.4734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.0085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.4819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003ePopulation\u0026ndash;Chair Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.0414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.0159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.0573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eGeographic\u0026ndash;Chair Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.3556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e0.3572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.7128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 7. Regional Contributions to Inequality in Resource Distribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003ePopulation\u0026ndash;Clinic Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.3726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.6274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eGeographic\u0026ndash;Clinic Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.4286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.5714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003ePopulation\u0026ndash;Chair Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.3369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.6631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eGeographic\u0026ndash;Chair Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.0734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e0.9266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Association Between Community Oral Health Resources and Residents\u0026rsquo; Health Status\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e6.3.1 Data Distribution and Normality Testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNormality testing indicated that the mean number of decayed, missing, and filled teeth (DMFT) for 5-year-olds, the caries prevalence among 12-year-olds, the periodontal health rate among 18-year-olds, and relevant oral healthcare resource indicators (such as the dental manpower index (21) and dentist density) all conformed to a normal distribution, confirming the suitability of the data for subsequent Pearson correlation analysis.\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis was performed to explore the associations between community oral health resource indicators and residents\u0026rsquo; oral health outcomes (including caries prevalence and periodontal health rate). The analysis yielded several notable findings. A significant positive correlation was observed between the dental manpower index and residents\u0026rsquo; periodontal health rate (r = 0.881, p \u0026lt; 0.05). Dentist density also demonstrated a significant positive correlation with periodontal health rate (r = 0.870, p \u0026lt; 0.05). Other resource indicators showed similar trends in their associations with oral health outcomes, although some did not reach statistical significance. For instance, the proportion of dentists with intermediate or senior professional titles was negatively correlated with caries prevalence among 12-year-old children (r = \u0026ndash;0.684), but this association was not statistically significant (p \u0026gt; 0.05). The proportion of staff with a bachelor\u0026rsquo;s degree or higher showed a weak, non-significant correlation with residents\u0026rsquo; overall oral health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. Pearson Correlation Between Community Oral Health Resource Indicators and Residents\u0026rsquo; Oral Health Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5-year-olds Mean dmft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5-year-olds Caries Prevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12-year-olds mean DMFT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12-year-olds Caries Prevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e18-year-olds mean DMFT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e18-year-olds Caries Prevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e18-year-olds\u0026apos; Periodontal Health Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eDental Workforce Index (\u0026times;10⁵ people)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.881*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eDentist-to-Population Ratio (\u0026times;10⁵ people)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.870*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eProportion of Staff Involved in Oral Health Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eProportion of Staff with Bachelor\u0026rsquo;s Degree or Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.690\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eProportion of Senior-Level Dental Professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05 ** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDrawing on field investigations of 249 community health service centers in Shanghai and data from the 2021 oral health epidemiological survey, this study systematically analyzed the current status of community oral healthcare resources allocation across multiple dimensions, including human resources, equipment configuration, regional disparities, equity assessment, and health outcomes. By integrating multisource data and applying multidimensional quantitative methods, the study identified the principal characteristics and challenges of Shanghai\u0026rsquo;s community dental care system in terms of resource structure, service positioning, and equity. The discussion addresses workforce structure, resource distribution patterns, equity evaluation, and associations with health outcomes, and presents recommendations for optimization within the framework of current health policy.\u003c/p\u003e\n\u003ch3\u003e1. Characteristics and Implications of the Community Dental Workforce Structure\u003c/h3\u003e\n\u003cp\u003eIn terms of human resources, the community dental workforce in Shanghai is predominantly female (78.2%) and primarily consists of young and middle-aged professionals (63.9% aged 44 years or younger). Staff with a bachelor\u0026rsquo;s degree or higher account for 76.6% of the team, whereas only 4.2% hold senior professional titles. This composition reflects the high overall educational attainment and younger workforce profile, aligning with national policies on hierarchical healthcare and strengthening primary care. The relatively low proportion of senior professionals is unlikely to compromise routine service delivery at the community level; on the contrary, it may accelerate the advancement of younger practitioners and invigorate primary care teams. However, these findings also underscore the need for stronger collaboration and support from tertiary care institutions, particularly in the referral of complex cases and in the continuing education and skill development of community dental staff, to enhance the overall capacity of regional health services.\u003c/p\u003e\n\u003ch3\u003e2. Current Status of Hardware Resource Allocation and Service Utilization\u003c/h3\u003e\n\u003cp\u003eRegarding equipment and facilities, suburban community health centers have a clear advantage in allocating dental hardware resources. The number of independent dental departments, registered dental chairs, and the total clinical space are all higher in suburban areas compared to central districts. Notably, the configuration of high-end equipment\u0026mdash;including dental CT scanners, implant systems, and laser therapy units\u0026mdash;is also greater in suburban districts, reflecting the positive outcomes of resource \u0026ldquo;downshifting\u0026rdquo; policies. This distribution pattern indicates that, alongside urban expansion and population migration, demand for dental services in suburban areas has risen substantially, and the capacity of primary care has been effectively enhanced. This trend is consistent with the growth in suburban populations and the expanding demand for oral health services, thereby improving both accessibility and equity at the primary care level. However, an increase in equipment quantity does not automatically translate into improved service capacity. Effective utilization of advanced equipment requires commensurate technical expertise among healthcare personnel and standardized management; otherwise, resources may be underutilized. Moving forward, it is essential to strengthen the training and technical support for primary care staff, optimize regional collaboration, and further enhance the overall effectiveness and quality of community oral healthcare services.\u003c/p\u003e\n\u003ch3\u003e3. Multidimensional Equity Assessment and Distribution Characteristics\u003c/h3\u003e\n\u003cp\u003eIn this study, the equity of community oral healthcare resources allocation in Shanghai was evaluated using three internationally recognized methods: the Lorenz curve, Gini coefficient, and Theil index, each offering distinct perspectives that complement one another in forming a robust analytic framework.\u003c/p\u003e\u003cp\u003eLorenz curve analysis revealed marked deviation from the line of absolute equality for the geographic distribution of dental department clinic space, the number of hospitals with independent dental departments, and the number of registered dental chairs, indicating significant spatial inequity in resource allocation. In contrast, the Lorenz curves for the population and economic dimensions were comparatively flatter, indicating a more balanced allocation of resources across these dimensions. These trends are closely aligned with the quantitative results of the Gini coefficient.\u003c/p\u003e\u003cp\u003eThe Gini coefficient, as a core indicator of overall equity, further quantifies multidimensional distribution characteristics. For hospitals with independent dental departments, the Gini coefficient was 0.151 (geographic), 0.357 (population), and 0.362 (GDP); for registered dental chairs, 0.356 (geographic), 0.420 (population), and 0.400 (GDP); and for dental department clinic space, 0.371 (geographic), 0.448 (population), and 0.430 (GDP). According to international grading standards, the geographic Gini coefficients, while not reaching the critical alert threshold, still warrant attention regarding spatial inequity. Meanwhile, coefficients for the population and economic dimensions fell within the \u0026ldquo;moderately equitable\u0026rdquo; to \u0026ldquo;alert\u0026rdquo; ranges, indicating a clear tendency for resources to cluster in densely populated and economically developed areas.\u003c/p\u003e\u003cp\u003eThe introduction of the Theil index allowed for deeper analysis of the sources of inequity. The Theil index for the geographic distribution of registered dental chairs reached 0.7128, substantially higher than that for community oral healthcare institutions (0.4819), indicating that the most significant disparities exist at the spatial level. Decomposition further demonstrated that suburban districts accounted for 0.9266 of the geographic disparity in dental chair distribution, far surpassing the contribution of central districts, and suggesting that overall inequity is mainly attributable to disparities within suburban areas. Conversely, Theil indices for the population dimension (0.0573 for registered dental chairs and 0.0444 for healthcare institutions) were significantly lower, reflecting adjustments in resource allocation to meet population needs.\u003c/p\u003e\u003cp\u003e In summary, the results from all three methods were highly consistent, revealing substantial spatial inequity, resource concentration in population and economic centers, and significant intra-suburban disparities in the distribution of Shanghai\u0026rsquo;s community oral healthcare resources. Although notable spatial inequity exists, the levels of equity in the population and economic dimensions are comparatively better, reflecting current strategies that prioritize the needs of the actual population and economic development, consistent with people-centered allocation principles. Nevertheless, spatial disparities\u0026mdash;especially in remote areas\u0026mdash;should not be ignored. Future strategies should not only strengthen equity across population and economic dimensions but also enhance spatial accessibility, ultimately achieving genuine equity and accessibility of dental healthcare services.\u003c/p\u003e\n\u003ch3\u003e4. Deviation in Community Health Center Positioning and Functional Reflection\u003c/h3\u003e\n\u003cp\u003eThe core mandate of community health centers (CHCs) is to provide essential medical care, preventive health services, and health management, rather than to deliver complex specialty treatments(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, this study found that some community dental departments\u0026mdash;across both central and suburban districts\u0026mdash;have inappropriately invested in high-end equipment (such as dental CT scanners and operating microscopes) and are performing advanced procedures, including dental implants and microscopic endodontic therapy. This has resulted in redundant infrastructure and undermined core primary care functions. Such a top-heavy approach has, in effect, transformed CHCs into \u0026ldquo;mini-specialty hospitals,\u0026rdquo; blurring their strategic role, diverting resources from public health programs (such as fluoride varnish for children and oral health screening for older adults), and weakening public trust in primary care. These dynamics may further exacerbate patient overflow to tertiary care facilities.\u003c/p\u003e\n\u003ch3\u003e5. Association Between Resource Allocation and Health Outcomes\u003c/h3\u003e\n\u003cp\u003e This study systematically assessed the association between the allocation of community oral healthcare resources and residents\u0026rsquo; oral health outcomes using Pearson correlation analysis. The analysis revealed a highly significant positive correlation between the dental manpower index and the periodontal health rate among individuals aged 18 years and older (r\u0026thinsp;=\u0026thinsp;0.881, p\u0026thinsp;=\u0026thinsp;0.020), as well as a strong positive correlation between dentist density and the periodontal health rate (r\u0026thinsp;=\u0026thinsp;0.870, p\u0026thinsp;=\u0026thinsp;0.024). These findings underscore the critical importance of adequately and appropriately distributing dental professional resources at the community level to improve periodontal health and achieve health equity. This evidence aligns with both domestic and international literature, further emphasizing the pivotal role of accessibility to oral healthcare resources in determining health outcomes.\u003c/p\u003e\u003cp\u003eAdditionally, specific indicators\u0026mdash;such as the proportion of dentists with intermediate or senior professional titles\u0026mdash;were negatively correlated with caries prevalence among 12-year-old children (r = \u0026minus;\u0026thinsp;0.684). However, this relationship did not reach statistical significance. This may suggest the potential value of highly qualified dentists in the prevention and management of pediatric caries. Notably, the proportion of staff with a bachelor\u0026rsquo;s degree or higher exhibited only a weak and non-significant association with oral health outcomes, suggesting that improvements in residents\u0026rsquo; oral health depend not solely on educational attainment or professional rank, but instead on the overall capacity and effectiveness of the dental care team and service delivery models.\u003c/p\u003e\n\u003ch3\u003e6. Policy Recommendations: Optimizing Hierarchical Healthcare and Resource Integration\u003c/h3\u003e\n\u003cp\u003eThe core functions of community health should be prioritized. At the community level, the integration of preventive care and basic clinical services should be emphasized, with continuous efforts to expand the coverage and improve the quality of public health initiatives. Rational allocation of equipment and workforce based on primary care needs is essential to prevent redundant construction and overinvestment, thereby ensuring that community health centers are equipped to meet fundamental oral health needs.\u003c/p\u003e\u003cp\u003eEnhancement of the hierarchical healthcare delivery system is also necessary. Leveraging Shanghai\u0026rsquo;s experience with the \u0026ldquo;family doctor system,\u0026rdquo; a multi-tiered oral health collaboration network should be established within the city. At the community level, primary care providers should focus on initial screening, early intervention for common and frequently occurring oral diseases, and promoting prevention-oriented models through health education. Secondary and tertiary care institutions should undertake more complex clinical responsibilities, providing technical support and expert consultation for challenging cases. Bidirectional referral pathways and remote collaboration should be developed to optimize resource allocation and reduce unnecessary duplication of services.\u003c/p\u003e\u003cp\u003eFurthermore, greater integration of public health and clinical services is warranted. This should be achieved through comprehensive community health planning and systematic training and professional support for primary care practitioners, with particular emphasis on the oral health needs of key populations such as children and the elderly. Dental professionals should be encouraged to participate in regular on-site outreach and capacity-building activities in the community, thereby strengthening cooperation across the continuum of prevention, diagnosis, and rehabilitation, and ultimately enhancing both the accessibility and quality of primary oral healthcare services, thereby achieving equity and efficiency in community oral healthcare.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study systematically evaluated the structure, equity, and health impact of the allocation of community oral healthcare resources in Shanghai. The results demonstrate that the current community dental workforce is relatively young and well-educated, and that the redistribution of hardware resources to the primary care level has progressed positively, with suburban districts now possessing a dominant share of dental infrastructure. Nevertheless, marked spatial inequities persist, especially in the geographic dimension, as revealed by the Lorenz curve, Gini coefficient, and Theil index. In contrast, equity in the population and economic dimensions is comparatively better, suggesting that resource allocation is more aligned with areas of population and economic concentration.\u003c/p\u003e\u003cp\u003eFurther analysis indicated that sufficient and appropriately distributed dental professional resources are strongly associated with improvements in residents\u0026rsquo; periodontal health, whereas simply increasing the proportion of highly educated or senior-ranked professionals exerts only a limited effect on health outcomes. In particular, community dental departments have seen an excessive allocation of high-end equipment, leading to a drift from their fundamental mission of providing basic care and prevention. This underscores the urgent need for policy realignment and structural optimization.\u003c/p\u003e\u003cp\u003eIn conclusion, optimizing community oral healthcare resources allocation in Shanghai requires continued enhancement of the hierarchical healthcare delivery system, rational planning and allocation of workforce and equipment, prioritization of public health functions at the primary care level, greater regional collaboration and talent development, and improvement of the homogeneity and equitable accessibility of oral healthcare services. Looking ahead, resource planning should be increasingly driven by actual health needs, with an emphasis on quality over quantity, to support sustained improvements in residents\u0026rsquo; oral health and contribute to the realization of the \u0026ldquo;Healthy China\u0026rdquo; strategic objectives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eHuman Ethics and consent to participate\u003c/p\u003e\n\u003cp id=\"_Toc23620\"\u003eThis study was approved by the Ethics Committee of the China Oral Health Foundation (COHF), with approval number COHF#2021-001 and an approval date of March 31, 2021. Participation was voluntary, and written informed consent was obtained from all participants. For child participants, consent was provided by their parents or legal guardians.\u003c/p\u003e\n\u003cp\u003eClinical trial number\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any person’s data.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eDue to participant privacy, the datasets used and/or analyzed during the current study are not publicly available but can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp id=\"_Toc9488\"\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eAuthor contribution statement\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to the conception and design of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDongxin Da, Junjie Xie, Shuran Yao, Jin Yu, Yiwei Jiang, Huning Wang\u0026nbsp;\u003c/strong\u003ewere involved in data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWenjie Song, Xiaoli Zeng, Hao Zhang, and Ying Zhang\u0026nbsp;\u003c/strong\u003ewere involved in data analysis and interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWenjie Song, Xiaoli Zeng\u0026nbsp;\u003c/strong\u003edrafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJing Zhu, Ying Zhang\u0026nbsp;\u003c/strong\u003erevised it critically for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJing Zhu, Ying Zhang\u003c/strong\u003e approved the final version to be published.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Key Discipline Program of the Sixth Round of the Three-Year Public Health Action Plan (2023-2025) of Shanghai (GWVI-11.1-31 and GWVI-11.1-16) and the National Oral Health Surveillance for Key Populations in 2021 [2020 (609)].\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe want to thank the staff of various district dental clinics in Shanghai for their valuable assistance with data collection during the project. We are also grateful to the funding bodies that supported this study: the Key Discipline Program of the Sixth Round of the Three-Year Public Health Action Plan (2023–2025) of Shanghai (GWVI-11.1-31 and GWVI-11.1-16), and the National Oral Health Surveillance for Key Populations in 2021 [2020 (609)].\u003c/p\u003e\n\u003cp\u003eAuthors information\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWenjie Song\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXiaoli Zeng\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHao Zhang\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDongxin Da\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJunjie Xie\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eShuran Yao\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJin Yu\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYiwei Jiang\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuning Wang\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003cp id=\"_Toc18380\"\u003eCorresponding authors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYing Zhang\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e ([email protected], (+86)13917555798, Shanghai Stomatological Hospital)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJing Zhu\u003c/strong\u003e\u003csup\u003eab\u003c/sup\u003e (primary, [email protected], Shanghai Stomatological Hospital)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitution\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea: Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China\u003c/p\u003e\n\u003cp\u003eb: Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSpanemberg JC, Cardoso JA, Slob E, L\u0026oacute;pez-L\u0026oacute;pez J. Quality of life related to oral health and its impact in adults. J Stomatol Oral Maxillofac Surg. 2019;120(3):234\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen MS, Hunter P. Oral health and quality of life in New Zealand: a social perspective. Soc Sci Med. 1996;43(8):1213\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen PE, The World Oral Health Report. 2003: continuous improvement of oral health in the 21st century\u0026ndash;the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31 Suppl 1:3\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The Global Burden of Oral Diseases and Risks to Oral Health. Bull World Health Organ. 2005;83(9):661\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFisher J, Selikowitz HS, Mathur M, Varenne B. Strengthening oral health for universal health coverage. Lancet. 2018;392(10151):899\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOgunbodede EO, Kida IA, Madjapa HS, Amedari M, Ehizele A, Mutave R, et al. Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region. Adv Dent Res. 2015;27(1):18\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXie X, Liu P, Zheng Y, Zhou W, Zou J, Wang X, et al. Equity of health resource distribution in China during 2009\u0026ndash;15: an analysis of cross-sectional nationwide data. Lancet. 2017;390:S6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Q, Wang B, Kong Y, Cheng KK. China's primary health-care reform. Lancet. 2011;377(9783):2064\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDong E, Xu J, Sun X, Xu T, Zhang L, Wang T. Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China. Archives Public Health. 2021;79(1):78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, et al. The Tsinghua\u0026ndash;Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet. 2018;391(10135):2140\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDong E, Liu S, Chen M, Wang H, Chen L-W, Xu T et al. Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China. BMJ Open. 2020;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y, Yu J, Jin L, Zhu Z, editors. The study on the equity of medical and health resources distribution in Shanghai. 2022 10th International Conference on Orange Technology (ICOT); 2022 10\u0026ndash;11 Nov. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarford J. Population ageing and dental care. Community Dent Oral Epidemiol. 2009;37(2):97\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhoury Z, Ferguson A, Price J, Sultan A, Wang R. Responsible artificial intelligence for addressing equity in oral healthcare. Front Oral Health. 2024;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Fourth National Oral Health Epidemiological Survey Technology Group CSA. Work manual of the fourth national oral health epidemiological survey (2015\u0026ndash;2018). Beijing: Chinese Stomatological Association; 2015. p. 8. 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Accessed 9 May 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLI Gang NZ-z. Designing Dental Manpower Index to Evaluate Dental Manpower Resources. West China J Stomatology. 2004;22(03):255\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChina NHCotPsRo. Guidelines for the assessment of service capacity of community health service centers (2019 edition). Beijing: National Health Commission; 2019. p. 2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community oral healthcare resources, Health resource allocation, Gini coefficient, Lorenz curve, Theil index, Caries prevalence, Oral health status","lastPublishedDoi":"10.21203/rs.3.rs-7019977/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7019977/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nThis study aimed to assess the distribution and equity of community oral healthcare resources in Shanghai and to examine their associations with population-level oral health indicators, including dental caries prevalence and periodontal health rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nData were collected from 249 community health service centers across 16 administrative districts in Shanghai, China, encompassing human resources, equipment allocation, and the implementation of public oral health programs. Additionally, clinical oral health data were obtained from sampled residents in selected districts. The equity of resource distribution was evaluated using Gini coefficients, Lorenz curves, and Theil indices. Pearson correlation analysis was conducted to explore the associations between resource indicators and oral health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nA total of 249 community health service centers, located across 16 districts in Shanghai, were surveyed. The dental public health workforce was predominantly female (78.2%) and relatively young, with 63.9% of the workforce aged 44 or younger. While 76.6% held a bachelor’s degree or higher, only 4.2% had senior professional titles. Suburban districts held 66.02% of registered dental chairs and 57.68% of clinic space. Also, they had higher counts of both basic equipment (e.g., dental chairs, ultrasonic scalers) and high-end devices such as implant systems, microscopes, and laser therapy units (see Table 3).\u003c/p\u003e\n\u003cp\u003eThe Gini coefficients for independent dental departments were 0.151 by geography, 0.357 by population, and 0.362 by economic output. For dental chairs, the corresponding values were 0.356, 0.420, and 0.400. The Theil index for the geographic distribution of dental chairs was 0.7128; suburban and urban values were 0.3809 and 0.0359, respectively. Suburban areas contributed 92.66% to the overall geographic inequality, while urban areas contributed 7.34%.\u003c/p\u003e\n\u003cp\u003eThe correlation between the Dental Manpower Index and periodontal health rate was 0.881 (p = 0.020); for the dentist-to-population ratio, the correlation was 0.870 (p = 0.024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\nNotable spatial disparities exist in the allocation of community oral healthcare resources in Shanghai, which may influence population oral health outcomes. Policy adjustments are recommended to enhance high-quality resource coverage in underserved areas and strengthen primary care capacity, thereby promoting oral health equity and efficiency.\u003c/p\u003e","manuscriptTitle":"Spatial Distribution of Community Oral Healthcare Resources and Their Association with Oral Health Status in Shanghai, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 10:25:31","doi":"10.21203/rs.3.rs-7019977/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"179199561361422358004666167523626765958","date":"2026-02-12T05:36:23+00:00","index":"hide","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-20T08:57:42+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T19:34:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T01:10:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-08T01:09:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-07-01T11:44:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"353513c5-06c5-41b3-b28f-33836dd6d50f","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T10:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-21 10:25:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7019977","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7019977","identity":"rs-7019977","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}