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Article(id=1311350609912095012, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511270, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763395200000, receivedDateStr=2025-11-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579949118, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579949118, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579949118, creator=13701087609, updateTime=1790579949118, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2975, endPage=2980, ext={EN=ArticleExt(id=1311350611514319141, articleId=1311350609912095012, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Distribution characteristics and equity analysis of methadone maintenance treatment resources in Guangdong, 2017-2022, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the spatial distribution characteristics and equity of methadone maintenance treatment (MMT) resources in Guangdong Province from 2017 to 2022，and to provide evidence for optimizing resource allocation.

Methods

Kernel density analysis was used to analyze the spatial distribution characteristics. The Gini coefficient, Lorenz curve, and Health resource agglomeration degree (HRAD) was employed to evaluate the overall and inter-regional equity of MMT resource allocation in Guangdong Province.

Results

The spatial distribution of MMT clinics in Guangdong Province showed significant clustering, mainly concentrated in the Pearl River Delta (PRD) region, Jieyang and Shantou City in the eastern region, and Zhanjiang and Maoming City in the western region of the province. From 2017 to 2022, the number of MMT participants in Guangdong Province decreased from 8 237 to 3 630, whereas the number of MMT clinics increased from 66 to 75. During the same period, the Gini coefficient increased from 0.22 in 2017 to 0.29 in 2021, and then decreased to 0.23 in 2022. The HRAD of MMT resource increased from 1.65 to 5.23, and then declined to 2.08 in 2022, with marked variation across regions. Taking the year 2020 as an example, HRAD across cities in Guangdong Province ranged between 0.46 to 73.79. Specifically, the western region had an HRAD closest to 1 (0.87), while the eastern region had the highest value of 18.13, followed by the northern region (6.03) and the PRD (1.65), respectively.

Conclusion

From 2017 to 2022, MMT resources in Guangdong Province showed a clustering distribution, mainly in PRD region. The overall allocation of MMT resource was relatively equitable; however, a significant inter-regional disparities remained, suggesting an oversupply in eastern and northern Guangdong. MMT resource allocation should therefore be dynamically adjusted according to the local scale and changing trends of MMT participants in order to improve equity and utilization efficiency.

, authors=Xi-Jia TANG1, 2, 3, Zi-Yi ZHANG3, Wen-Xue XIONG3, He-Xuan WANG3, Li LING3, Liang ZHOU1, 2, authorsList=Xi-Jia TANG, Zi-Yi ZHANG, Wen-Xue XIONG, He-Xuan WANG, Li LING, Liang ZHOU, authorCompany=null, correspAuthors=Li LING, Liang ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350612835524910, articleId=1311350609912095012, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2017—2022年广东省美沙酮维持治疗资源分布特征及公平性分析, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

分析2017—2022年广东省美沙酮维持治疗（Methadone maintenance treatment, MMT）资源分布特征及配置公平性，为优化资源配置提供依据。

方法

采用核密度分析法分析广东省MMT资源空间分布特征；利用基尼系数和洛伦兹曲线评价广东省MMT资源配置总体公平性；利用卫生资源集聚度评价地区间资源配置公平，集聚度越接近1表示资源配置越均衡。

结果

广东省MMT门诊空间分布呈明显聚集性，主要集中于珠三角地区、粤东地区的揭阳市、汕头市以及粤西地区的湛江、茂名市。2017—2022年，广东省MMT在治人数由8 237人下降至3 630人，MMT门诊数从66家增加至75家。同期，MMT资源配置基尼系数从0.22增加至2021年的0.29，2022年降至0.23；MMT资源集聚度从1.65增加至2021年的5.23，2022年回落至2.08。不同地区间集聚度均值差异明显。以2020年为例，广东省各市MMT资源集聚度为0.46~73.79；其中，粤西地区集聚度均值最接近1，为0.87；粤东集聚度均值最高，为18.13；粤北地区及珠三角地区分别为6.03和1.65。

结论

2017—2022年，广东省MMT资源呈聚集性分布，资源配置总体公平性较好，但地区间差异明显；粤东及粤北地区资源集聚度高，供过于求现状突出。 建议相关部门结合各地MMT在治人数规模及变化趋势，动态调整MMT资源配置，提高资源利用效率及公平性。

, authors=唐夕佳1, 2, 3, 张紫怡3, 熊文学3, 王鹤璇3, 凌莉3, 周亮1, 2, authorsList=唐夕佳, 张紫怡, 熊文学, 王鹤璇, 凌莉, 周亮, authorCompany=null, correspAuthors=凌莉, 周亮, authorNote=

唐夕佳（1994—），女，博士，研究方向：美沙酮维持治疗服务利用；卫生资源配置；公共精神卫生

, correspAuthorsNote=
凌莉与周亮为共同通信作者
凌莉，E-mail：
周亮，E-mail：
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2.广东省精神疾病转化医学工程技术研究中心
3.中山大学公共卫生学院, bio={"content":"

唐夕佳（1994—），女，博士，研究方向：美沙酮维持治疗服务利用；卫生资源配置；公共精神卫生

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唐夕佳（1994—），女，博士，研究方向：美沙酮维持治疗服务利用；卫生资源配置；公共精神卫生

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National methadone maintenance therapy and HIV/AIDS prevention and control ［R］. Beijing: National Center for AIDS/STD Control and Prevention, 2023.(In Chinese), articleTitle=National methadone maintenance therapy and HIV/AIDS prevention and control, refAbstract=null), Reference(id=1311350621526122866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2024, volume=22, issue=1, pageStart=18, pageEnd=null, url=null, language=null, rfNumber=[3], rfOrder=3, authorNames=Tang XJ, Xiong WX, Chen W, journalName=BMC Medicine, refType=null, unstructuredReference=Tang XJ, Xiong WX, Chen W, et al. Benefits and challenges experienced by participants on long-term methadone maintenance treatment in China: a qualitative study［J］. 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(In Chinese), articleTitle=Information on methadone maintenance treatment clinics in Guangdong province, refAbstract=null), Reference(id=1311350624822845831, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2015, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[16], rfOrder=24, authorNames=食品药品监管总局, 卫生计生委, 公安部, journalName=null, refType=null, unstructuredReference=食品药品监管总局，卫生计生委，公安部．关于印发戒毒药物维持治疗工作管理办法的通知［R］．北京：国家卫生和计划生育委员会，2015．, articleTitle=关于印发戒毒药物维持治疗工作管理办法的通知, refAbstract=null), Reference(id=1311350624894149000, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2015, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[16], rfOrder=25, authorNames=National Health and Family Planning Commission, China Food and Drug Administration, Ministry of Public Security, journalName=null, refType=null, unstructuredReference=National Health and Family Planning Commission, China Food and Drug Administration, Ministry of Public Security. Notice on issuing the administrative measures for drug maintenance treatment ［R］. Beijing: National Health and Family Planning Commission, 2015.(In Chinese), articleTitle=Notice on issuing the administrative measures for drug maintenance treatment, refAbstract=null), Reference(id=1311350624986423689, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2019, volume=35, issue=7, pageStart=872, pageEnd=875, url=null, language=null, rfNumber=[17], rfOrder=26, authorNames=张丽琼, 沈九成, 张从斌, journalName=中国公共卫生, refType=null, unstructuredReference=张丽琼，沈九成，张从斌，等．云南省不同地区美沙酮维持治疗成本分析［J］．中国公共卫生，2019，35(7)：872-875．, articleTitle=云南省不同地区美沙酮维持治疗成本分析, refAbstract=null), Reference(id=1311350625053532554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2019, volume=35, issue=7, pageStart=872, pageEnd=875, url=null, language=null, rfNumber=[17], rfOrder=27, authorNames=Zhang LQ, Shen JC, Zhang CB, journalName=Chinese Journal of Public Health, refType=null, unstructuredReference=Zhang LQ, Shen JC, Zhang CB, et al. Cost and compliance of methadone maintenance treatment among drug users in different regions of Yunnan province［J］. Chinese Journal of Public Health, 2019, 35(7): 872-875.(In Chinese), articleTitle=Cost and compliance of methadone maintenance treatment among drug users in different regions of Yunnan province, refAbstract=null), Reference(id=1311350625120641419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, doi=null, pmid=null, pmcid=null, year=2024, volume=19, issue=1, pageStart=18, pageEnd=null, url=null, language=null, rfNumber=[18], rfOrder=28, authorNames=Chung YCE, Tung YC, Wang SC, journalName=Implementation Science, refType=null, unstructuredReference=Chung YCE, Tung YC, Wang SC, et al. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis［J］. 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注:图A为2017年广东省各地级市MMT在治人数分布情况；图B为2019年广东省各地级市MMT在治人数分布情况；图C为2020年广东省各地级市MMT在治人数分布情况；图D为2022年广东省各地级市MMT在治人数分布情况（底图基于广东省自然资源厅标准地图粤S(2022)226号绘制，边界未修改，下同）。

, figureFileSmall=7cUaZNERh2ghcQgm1vauBA==, figureFileBig=ywTUPoFpkXFlDxegllX8Ww==, tableContent=null), ArticleFig(id=1311350620347523427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=EN, label=Fig.2, caption=The spatial distributionof MMT clinics in Guangdong province, figureFileSmall=UWHz8c9TBGhNPKL9fe8ovw==, figureFileBig=GqF0/b8rrWeRYcF2IT6i3g==, tableContent=null), ArticleFig(id=1311350620431409508, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=CN, label=图2, caption=广东省MMT门诊空间分布图, figureFileSmall=UWHz8c9TBGhNPKL9fe8ovw==, figureFileBig=GqF0/b8rrWeRYcF2IT6i3g==, tableContent=null), ArticleFig(id=1311350620519489893, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=EN, label=Fig.3, caption=Lorenz curves of MMT outpatient services in Guangdong province by population under treatment, 2017-2022, figureFileSmall=v9/ZaRBwVNssK3vzf6l2EA==, figureFileBig=2QVVc1iQyUvkfxaSwVIUkw==, tableContent=null), ArticleFig(id=1311350620594987366, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=CN, label=图3, caption=2017—2022年广东省MMT门诊按在治人口分布的洛伦兹曲线, figureFileSmall=v9/ZaRBwVNssK3vzf6l2EA==, figureFileBig=2QVVc1iQyUvkfxaSwVIUkw==, tableContent=null), ArticleFig(id=1311350620674679143, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=EN, label=Fig.4, caption=Changes in HRAD of MMT resources in Guangdong province, 2017-2022, figureFileSmall=TrCodB6uSV7JJMLBpdAaaQ==, figureFileBig=4vB4YfUXtiBzYnLM4ghckg==, tableContent=null), ArticleFig(id=1311350620745982312, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=CN, label=图4, caption=2017—2022年广东省MMT门诊集聚度变化

注:图A为2017年广东省各地级市MMT资源集聚度分布；图B为2019年广东省各地级市MMT资源集聚度分布；图C为2020年广东省各地级市MMT资源集聚度分布；图D为2022年广东省各地级市MMT资源集聚度分布。

, figureFileSmall=TrCodB6uSV7JJMLBpdAaaQ==, figureFileBig=4vB4YfUXtiBzYnLM4ghckg==, tableContent=null), ArticleFig(id=1311350620804702569, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=EN, label=Table 1, caption=

The number of participants, clinics and the Gini efficient of MMT in Guangdong province, 2017- 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
年份MMT在治人数MMT门诊数基尼系数
20178 237660.218
20187 723700.233
20197 007700.234
20205 534750.273
20214 641750.292
20223 630750.228
), ArticleFig(id=1311350620892782954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=CN, label=表1, caption=

2017—2022年广东省MMT在治人数、门诊数及资源配置的基尼系数

, figureFileSmall=null, figureFileBig=null, tableContent=
年份MMT在治人数MMT门诊数基尼系数
20178 237660.218
20187 723700.233
20197 007700.234
20205 534750.273
20214 641750.292
20223 630750.228
), ArticleFig(id=1311350620989251947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=EN, label=Table 2, caption=

The resource agglomeration degree of MMT resource in prefecture-level cities of Guangdong province, 2017-2022

, figureFileSmall=null, figureFileBig=null, tableContent=
区域城市年份平均值
201720182019202020212022
广州市0.560.550.590.640.720.740.63
江门市1.110.821.100.910.850.800.93
佛山市0.981.001.320.980.980.921.03
深圳市1.401.481.441.421.441.371.43
珠三角肇庆市1.110.890.821.351.551.531.211.65
东莞市1.432.491.382.282.261.961.97
珠海市2.554.162.861.321.211.052.19
惠州市4.994.605.015.273.643.034.42
中山市1.191.210.631.211.070.951.04
汕尾市1.131.221.221.281.601.921.40
粤东地区汕头市1.171.081.180.960.700.921.0018.13
揭阳市1.191.493.132.912.582.342.27
潮州市a---73.7961.89-67.84
阳江市0.950.910.870.690.690.640.79
粤西地区茂名市1.001.021.041.431.351.201.170.87
湛江市0.791.040.620.460.430.520.64
云浮市2.571.241.282.682.502.452.12
粤北地区清远市2.452.212.282.353.263.162.626.03
韶关市3.122.632.574.613.446.053.74
河源市a-22.0711.1224.6012.388.0715.65
平均值b1.652.742.136.565.232.085.70-
), ArticleFig(id=1311350621068943724, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350609912095012, language=CN, label=表2, caption=

2017—2022年广东省各地级市MMT资源集聚度

, figureFileSmall=null, figureFileBig=null, tableContent=
区域城市年份平均值
201720182019202020212022
广州市0.560.550.590.640.720.740.63
江门市1.110.821.100.910.850.800.93
佛山市0.981.001.320.980.980.921.03
深圳市1.401.481.441.421.441.371.43
珠三角肇庆市1.110.890.821.351.551.531.211.65
东莞市1.432.491.382.282.261.961.97
珠海市2.554.162.861.321.211.052.19
惠州市4.994.605.015.273.643.034.42
中山市1.191.210.631.211.070.951.04
汕尾市1.131.221.221.281.601.921.40
粤东地区汕头市1.171.081.180.960.700.921.0018.13
揭阳市1.191.493.132.912.582.342.27
潮州市a---73.7961.89-67.84
阳江市0.950.910.870.690.690.640.79
粤西地区茂名市1.001.021.041.431.351.201.170.87
湛江市0.791.040.620.460.430.520.64
云浮市2.571.241.282.682.502.452.12
粤北地区清远市2.452.212.282.353.263.162.626.03
韶关市3.122.632.574.613.446.053.74
河源市a-22.0711.1224.6012.388.0715.65
平均值b1.652.742.136.565.232.085.70-
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2017—2022年广东省美沙酮维持治疗资源分布特征及公平性分析
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唐夕佳 1, 2, 3 , 张紫怡 3 , 熊文学 3 , 王鹤璇 3 , 凌莉 3 , 周亮 1, 2
现代预防医学 | 卫生政策与管理 2026,53(16): 2975-2980
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现代预防医学 |卫生政策与管理 2026 , 53 (16) : 2975 -2980
2017—2022年广东省美沙酮维持治疗资源分布特征及公平性分析
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唐夕佳1, 2, 3, 张紫怡3, 熊文学3, 王鹤璇3, 凌莉3 , 周亮1, 2
作者信息
  • 1.广州医科大学附属脑科医院，广东 广州 510370
  • 2.广东省精神疾病转化医学工程技术研究中心
  • 3.中山大学公共卫生学院
通讯作者:
凌莉与周亮为共同通信作者
凌莉，E-mail：
周亮，E-mail：
作者简介:

唐夕佳（1994—），女，博士，研究方向：美沙酮维持治疗服务利用；卫生资源配置；公共精神卫生

Distribution characteristics and equity analysis of methadone maintenance treatment resources in Guangdong, 2017-2022
Xi-Jia TANG1, 2, 3, Zi-Yi ZHANG3, Wen-Xue XIONG3, He-Xuan WANG3, Li LING3 , Liang ZHOU1, 2
Affiliations
  • The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202511270
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目的

分析2017—2022年广东省美沙酮维持治疗（Methadone maintenance treatment, MMT）资源分布特征及配置公平性，为优化资源配置提供依据。

方法

采用核密度分析法分析广东省MMT资源空间分布特征；利用基尼系数和洛伦兹曲线评价广东省MMT资源配置总体公平性；利用卫生资源集聚度评价地区间资源配置公平，集聚度越接近1表示资源配置越均衡。

结果

广东省MMT门诊空间分布呈明显聚集性，主要集中于珠三角地区、粤东地区的揭阳市、汕头市以及粤西地区的湛江、茂名市。2017—2022年，广东省MMT在治人数由8 237人下降至3 630人，MMT门诊数从66家增加至75家。同期，MMT资源配置基尼系数从0.22增加至2021年的0.29，2022年降至0.23；MMT资源集聚度从1.65增加至2021年的5.23，2022年回落至2.08。不同地区间集聚度均值差异明显。以2020年为例，广东省各市MMT资源集聚度为0.46~73.79；其中，粤西地区集聚度均值最接近1，为0.87；粤东集聚度均值最高，为18.13；粤北地区及珠三角地区分别为6.03和1.65。

结论

2017—2022年，广东省MMT资源呈聚集性分布，资源配置总体公平性较好，但地区间差异明显；粤东及粤北地区资源集聚度高，供过于求现状突出。 建议相关部门结合各地MMT在治人数规模及变化趋势，动态调整MMT资源配置，提高资源利用效率及公平性。

美沙酮维持治疗  /  医疗资源  /  空间分布  /  公平性分析  /  卫生集聚度
Objective

To analyze the spatial distribution characteristics and equity of methadone maintenance treatment (MMT) resources in Guangdong Province from 2017 to 2022，and to provide evidence for optimizing resource allocation.

Methods

Kernel density analysis was used to analyze the spatial distribution characteristics. The Gini coefficient, Lorenz curve, and Health resource agglomeration degree (HRAD) was employed to evaluate the overall and inter-regional equity of MMT resource allocation in Guangdong Province.

Results

The spatial distribution of MMT clinics in Guangdong Province showed significant clustering, mainly concentrated in the Pearl River Delta (PRD) region, Jieyang and Shantou City in the eastern region, and Zhanjiang and Maoming City in the western region of the province. From 2017 to 2022, the number of MMT participants in Guangdong Province decreased from 8 237 to 3 630, whereas the number of MMT clinics increased from 66 to 75. During the same period, the Gini coefficient increased from 0.22 in 2017 to 0.29 in 2021, and then decreased to 0.23 in 2022. The HRAD of MMT resource increased from 1.65 to 5.23, and then declined to 2.08 in 2022, with marked variation across regions. Taking the year 2020 as an example, HRAD across cities in Guangdong Province ranged between 0.46 to 73.79. Specifically, the western region had an HRAD closest to 1 (0.87), while the eastern region had the highest value of 18.13, followed by the northern region (6.03) and the PRD (1.65), respectively.

Conclusion

From 2017 to 2022, MMT resources in Guangdong Province showed a clustering distribution, mainly in PRD region. The overall allocation of MMT resource was relatively equitable; however, a significant inter-regional disparities remained, suggesting an oversupply in eastern and northern Guangdong. MMT resource allocation should therefore be dynamically adjusted according to the local scale and changing trends of MMT participants in order to improve equity and utilization efficiency.

Methadone maintenance treatment  /  Health resources  /  Spatial distribution  /  Equity analysis  /  Health resource agglomeration degree
唐夕佳, 张紫怡, 熊文学, 王鹤璇, 凌莉, 周亮. 2017—2022年广东省美沙酮维持治疗资源分布特征及公平性分析. 现代预防医学, 2026 , 53 (16) : 2975 -2980 . DOI: 10.20043/j.cnki.MPM.202511270
Xi-Jia TANG, Zi-Yi ZHANG, Wen-Xue XIONG, He-Xuan WANG, Li LING, Liang ZHOU. Distribution characteristics and equity analysis of methadone maintenance treatment resources in Guangdong, 2017-2022[J]. Modern Preventive Medicine, 2026 , 53 (16) : 2975 -2980 . DOI: 10.20043/j.cnki.MPM.202511270
正文
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美沙酮维持治疗（Methadone Maintenance Treatment, MMT）是公认有效的阿片类物质成瘾替代疗法，自2006年在我国正式实施以来迅速发展。截至2023年，全国30个省（市）共有796家MMT门诊，规模为世界之首［1-2］。广东省作为既往毒情较严重省份，MMT项目开展早、规模大。截至2023年，全省共有75家MMT门诊，数量居全国首位［2］。实施20余年来，MMT在减少阿片类物质使用、降低成瘾者HIV、HCV感染率等方面取得了显著成效［3］。然而，近年来，全国MMT在治人数普遍减少，从2012年的20.8万人下降至2022年的5.6万人；同时，全国MMT门诊的数量从2012年的701家增加至2022年的796家。这一现象可能改变MMT服务的供需关系，进而影响资源配置的公平性。
作为一项对特殊人群的公共卫生项目，MMT资源配置的公平性与合理性对该项目的治疗效果、可及性及长期稳定发展至关重要［4］。然而，当前我国MMT资源配置的公平性存在诸多挑战：一是MMT资源分布不均。全国MMT门诊主要分布在广东、贵州、广西、云南等既往海洛因滥用问题较严峻省份［2］，门诊数量占全国门诊总数的42.5%［3］。广东省内亦存在明显差异，如广州市共有12家MMT门诊，800余名在治者，而粤东地区的潮州市仅有1家门诊，日均服药人数1人［5］；二是人力资源短缺且专业水平不一。既往研究指出，MMT门诊员工职业倦怠感强、人员流动性大［6］。广东省75%的门诊员工为单位指派，并非自愿选择，对薪资与发展前景满意度较低［7］；11%的员工工作年限不足一年，且仅有51%接受过省级以上职业培训，导致其在处理药物剂量调整、社区转介等复杂工作时存在一定困难［8］；另有省份报告，仅有65%的MMT门诊的人员配备符合国家要求，员工离职率高达48%［9］；三是资金短缺，已成为制约门诊良性运营的重要的挑战［10］。随着在治人数的不断减少，许多门诊出现了收益由盈转亏或亏损加剧的现象［2］。因此，有必要基于在治人数减少这一现状，深入探究我国MMT门诊资源的配置现状及公平性，为制定相关政策以保证MMT治疗效果及项目良性，提供可参考的理论依据。
当前国内外MMT相关研究主要集中于在治者HIV/HCV感染、复吸、剂量调整等内容［11-12］，缺乏有关MMT资源分布特征及配置公平性的研究。现有常规医疗资源配置研究已形成较为成熟的研究框架，例如利用核密度分析医疗资源空间聚集性，利用基尼系数、洛伦兹曲线及卫生集聚度评价资源配置公平性［13-14］，但这些方法尚未应用于MMT相关研究。此外，尽管有部分研究关注到MMT在治人数下降这一现状［3］，但未探讨可能对MMT资源配置公平性和项目实施效果造成的潜在影响。基于此，本研究拟以广东省为例，分析2017—2022年该省MMT资源的空间分布特征、公平性及变化情况，为优化MMT资源配置、制定适应在治人数下降趋势的资源优化策略提供参考依据。
1　资料与方法
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1.1　研究对象
广东省全部75家MMT门诊
1.2　调查内容和方法
广东省MMT门诊的地理位置来自广东省疾控中心网站［15］，各门诊经纬度通过高德开放平台的地理编码功能获取。2017—2022年广东省各地级市MMT在治人数及门诊数均来源于广东省疾控中心报告。
1.3　研究方法
MMT属于一类特殊的公共卫生服务，参考既往卫生资源研究方法，利用GIS技术中的核密度分析法（Kernel Density Estimation）分析广东省MMT门诊空间分布特征；利用基尼系数、洛伦兹曲线和卫生集聚度（Health Resource Agglomeration Degree, HRAD）分析2017—2022年广东省MMT资源分布整体和区域间的公平性。
核密度分析及可视化通过Arcmap10.8软件完成，资源配置公平性分析及可视化通过R 4.4.4软件实现。本研究已通过中山大学公共卫生学院伦理委员会批准（No.2020-39）。
2　结果
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2.1　2017—2022年广东省MMT在治人数分布情况
2017—2022年，广东省各地级市MMT在治人数分布情况见图1。MMT在治者主要集中在珠三角地区的广州市、深圳市、江门市等以及粤西地区的湛江市，各地级市的在治人数普遍出现不同程度的减少。
2.2　广东省MMT资源空间分布特征
广东省MMT门诊分布的核密度分析结果见图2。结果显示，广东省MMT门诊分布的聚集性较为明显，核密度较高的地区主要集中在广州市、佛山市、江门市、深圳市等所在的珠三角地区；另外还集中在粤西地区的湛江市、茂名市以及粤东地区的揭阳市、汕头市。
2.3　2017—2022年广东省MMT资源配置的洛伦兹曲线及基尼系数
2017—2022年，广东MMT门诊资源配置的洛伦兹曲线下面积逐渐增加，代表MMT资源配置公平性逐渐降低，见图3；其中，2022年的资源配置公平性有所上升，与2019年水平接近。
2017—2022年广东省按在治人口分布的MMT资源配置的基数系数范围为0.218~0.292，均接近0.2,可认为资源配置公平性较好（见表1）。具体来看，2017—2021年，基尼系数从0.218上升至0.292，同时，广东省MMT在治人数从8 237人下降至3 630人，MMT门诊数从66家增加至75家，提示在治人数下降的同时门诊数增加，可能导致了资源配置不公平性加剧。2022年，基尼系数下降至0.228。
2.4　2017—2022年广东省MMT资源集聚度分析结果
广东省MMT资源集聚度均值从2017年的1.65增加至2021年的5.23，2022年回落至2.08（见表2）。结合图4可进一步得出，与2017年相比，2021年MMT资源集聚度均值处于0.9-1.2，即资源配置相对公平的城市数，从9个（江门、佛山、肇庆、中山、汕尾、汕头、揭阳、阳江、茂名）减少至2个（佛山、中山），2022年又增加为4个（佛山、珠海、中山、茂名）。广东省MMT资源配置的公平性地区间差异明显。以2020年为例，广东省各地市MMT资源集聚度范围在0.46~73.79，相差160.4倍。广州市MMT资源集聚度最低，为0.63。潮州市的MMT资源集聚度最高，为67.84。从区域水平看，粤西地区资源集聚度均值最接近1，为0.87；珠三角地区资源集聚度均值为1.65；粤东及粤北地区集聚度较高可能受到潮州市、河源市两地新开设MMT门诊的影响。
3　讨论
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本研究基于全国及广东省MMT人数持续下降的背景，综合分析了该省2017—2022年MMT资源的空间分布特征及公平性。结果显示，广东省MMT资源总体呈聚集性分布，资源配置总体公平性尚可，但地区间差异明显；在治人数下降与门诊资源调整共同影响了MMT资源配置公平性和资源利用效率。
3.1　广东省MMT资源分布主要聚集于MMT在治人数较多地区，但在治人数的普遍下降或降低部分地区资源配置效率
广东省MMT资源分布呈现明显的聚集性，主要集中在珠三角地区的广州市、佛山市、江门市、深圳市，粤西地区的湛江市、茂名市及粤东地区的揭阳市、汕头市。总体来看，MMT门诊的分布与在治人数的分布基本一致，满足国家卫健委“MMT门诊应设立在阿片类物质成瘾者相对集中的地区”的要求［16］，提示广东省MMT资源布局具有一定合理性。然而，2017—2022年，全省各地级市的MMT在治人数普遍下降，降幅较大的地区即包括广州、深圳等既往在治人数较多的城市，也包括韶关、清远等在治人数规模较小、资源相对有限的地区。既往基于我国云南MMT门诊研究显示，资源匮乏地区的在治者依从性更差且高度依赖于财政补贴［17］。对于此类地区，在治人数的减少可能导致当地MMT门诊日均在治人数处于极低水平，导致运营成本增加，资源利用不足，加重门诊及隶属机构的财政负担。因此，对于MMT在治人数规模小且门诊数较多的地区，尤其是经济欠发达、资源调配能力有限城市，应及时评估门诊运营负荷，及时调整资源配置，以保障MMT项目持续运行。
3.2　广东省MMT资源配置公平性总体尚可，但地区间差异明显且受到在治人数下降影响
2017—2022年，广东省按在治人数分布的MMT资源基尼系数整体接近0.2，提示MMT资源配置总体公平性尚可。但从变化趋势看，在治人数下降与资源供给共同影响了资源配置公平性。具体而言，2017—2021年，广东省MMT在治人数从8 192下降至4 635人，基尼系数从0.218增加至0.292。这一期间内，全省MMT门诊数从66家增加至75家［5］。这一在治人数减少而门诊数量增加的情况，造成部分地区资源配置与实际需求之间的匹配程度下降，从而影响了总体资源配置公平性。从区域层面看，广东省各地级市之间MMT资源配置公平性差异明显。珠三角地区以及粤西部分城市MMT门诊数与在治人数均较多，但HRAD低于1，提示相对于在治人数规模而言，门诊资源仍可能不足。以广州市为例，作为MMT在治人数及门诊数最多的城市，HRAD均值为所有城市中最低，提示资源供不应求的情况较为突出。在治人数的减少一定程度上改善了当地MMT资源配置公平性，但同一城市内不同门诊之间仍可能存在服药人数、人力配置和服务能力差异，因此仍需进一步开展精细化资源调整。对于粤北及粤西部分地区MMT门诊和在治人数均较少，但HRAD较高，在治人数下降进一步放大了这类地区资源利用不足的问题。若同时叠加经济发展水平有限，财政支持和资源配置能力欠缺，可能影响MMT服务可及性和实施效果。因此，MMT资源配置公平性评价不仅应关注全省总体水平，也应重视地区间差异及其背后的服务需求变化。
3.3　基于在治人数规模及变化情况动态调整MMT资源配置，有助于改善资源配置公平性
本研究结果提示，基于MMT在治人数规模及变化趋势对资源配置进行合理调整和优化，可有效提升资源配置公平性。具体而言，2022年，全省资源配置的公平性较2021年有所提升，基尼系数由0.292下降至0.228，MMT资源集聚度均值由5.23下降至2.08。进一步分析发现，2022年潮州市撤销了当地唯一一家MMT门诊，该门诊日均服药人数仅为1人［5］，资源供给明显高于实际服务需求。撤销门诊后，全省资源配置公平性得到改善。另外，增加资源供给相对不足地区的供给也可改善公平性。以汕头市为例，2020至2021年，该市MMT在治人数从154人增加至177人，门诊数未变，因此MMT资源集聚度从0.96下降至0.70。为应对这一情况，2022年该市新增一家MMT门诊，MMT资源集聚度相应上升至0.92，提示资源配置与服务需求的匹配程度提高，公平性得到改善。
上述结果表明， MMT资源配置策略优化既需要根据总体MMT在治人数的变化进行动态调整，也需结合地区间MMT在治人数及门诊规模、资源配置能力以及经济发展水平因地制宜制定策略。在在治人数普遍下降的背景下，对于在治人数少且资源相对有限的地区，可通过合并门诊、降级为延伸服药点或将MMT服务与社区卫生工作相结合等方式，在保证在治者治疗连续性的基础上，加强各部门间合作，降低运营成本，提高资源利用效率［5］ ；同时，隶属机构及上级单位应根据门诊实际服务量和运行成本，适当增加必要的经费支持，以维持项目的政策运转；对于MMT规模较大或资源供不应求的地区，可通过增设门诊、延长开诊时间等方式提高资源利用效率，提高服务可及性和良性运行。此外，各地可建立MMT在治人数动态监测机制，定期评估门诊服务量、在治人数变化、资源利用效率及在治者服务需求。一方面，加强在治者管理，通过开展访谈、科普宣教等活动，了解其当前面临的困难［18］，如门诊营业时长缩短或门诊合并带来的服药困难，联合社区、公安等部门提供相应的解决方案，以提高在治者依从性，保证MMT效果；另一方面，应对未来一段时期内在治人数变化进行预测，提前制定相应的资源配置方案，以提升MMT资源的利用率，避免资源配置滞后于实际的需求变化。
综上，广东省MMT资源呈聚集性分布，资源配置公平性总体尚可，但地区间差异明显大。在治人数减少对资源配置公平性产生了一定影响，基于在治人数规模变化进行动态优化调整，有助于提升MMT资源配置公平性。本研究首次将常规医疗资源研究的思路及分析方法应用于MMT领域，探究了广东省MMT资源配置的分布特征及公平性，填补了当前研究空白，也可为今后类似研究提供方法学参考。
本研究仍存在一定局限性。首先，受吸毒相关数据获取限制，本研究仅纳入了广东省部分城市的MMT门诊，结果外推性可能受到一定影响。但本研究纳入的门诊来自全国MMT门诊数量最多的广东省，门诊所在地包括了省内经济较为发达及欠发达地区，隶属单位包括了综合医院、疾控中心等多个不同类型机构，研究样本仍具有一定代表性。其次，本研究主要基于门诊数量和在治人数评价资源配置公平性，后续研究可进一步整合经费投入、治疗依从性多维度数据，对MMT资源配置效率及服务效果进行综合评价。
基金
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  • 国家自然科学基金(82073664; 82471574)
  • 广州市临床重点专科（临床医学研究所）
文献
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2026年第53卷第16期
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doi: 10.20043/j.cnki.MPM.202511270
  • 接收时间：2025-11-18
  • 首发时间：2026-09-28
  • 出版时间：2026-08-25
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  • 收稿日期：2025-11-18
基金
国家自然科学基金(82073664; 82471574)
广州市临床重点专科（临床医学研究所）
作者信息
    1.广州医科大学附属脑科医院，广东 广州 510370
    2.广东省精神疾病转化医学工程技术研究中心
    3.中山大学公共卫生学院

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小菇属 Mycena 11 5.26
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