Accessibility of hospice care services in Shanghai: a geographical network analysis

OBJECTIVES: This study assesses the accessibility of hospice care services in Shanghai, China, with emphasis on their spatial distribution and network accessibility. METHODS: Using Geographic Information Systems (GIS), the study integrated spatial data on 261 hospices in Shanghai by 2024 with road networks, administrative boundaries, and population distribution. Network analysis tools in ArcGIS Pro were used to evaluate service coverage based on physical distances, driving time, population density, and hospices per capita. RESULTS: Citywide, 97.8% of Shanghai's 24.5 million residents lived within 15 km of a hospice, and 98.9% could reach one within a 30-min drive, levels comparable to many Western cities. Central districts such as Huangpu, Hongkou, and Jing'an achieved full coverage within 5 km or a 10-min drive. By contrast, only 24.1% of Chongming District residents and fewer than 1% of residents in several towns of Pudong and Songjiang Districts met these thresholds. When measured by hospices per capita (both total and older populations), suburban areas had smaller numbers than central and peripheral districts. Overall, spatial accessibility in suburbs and peripheral districts remained limited due to lower facility density and restricted expressway connections, reflecting a pronounced core-periphery divide in hospice service provision. DISCUSSION: Shanghai's dense hospice network and advanced transport infrastructure ensure near-universal access in central districts. Yet, persistent inequalities in suburban and rural areas underscore the need for equitable end-of-life care amid rapid population aging. Expanding facility placement, strengthening home- and community-based hospice models, and leveraging tele-hospice platforms are essential to meeting the city's growing age-related care demands.