Central China Region Research Articles

Genome analysis and recombination characterization of duck hepatitis B virus isolated from ducks and geese in central China, 2017 to 2019

Owing to its high similarity to human hepatitis B virus (HBV), duck HBV (DHBV) is often used as an essential model for HBV research. Although intergenotypic recombination of HBV is common, it remains unclear whether the intergenotypic recombination of human HBV is exactly the same as that of DHBV. In this study, 119 serum samples of duck and goose were collected from 51 farms (29 duck and 22 goose farms) in the central and eastern regions of China. A total of 22 strains isolated from the 22 DHBV positive flock were sequenced. Genome sequence alignment revealed that the duck- and goose-origin strains shared the highest and lowest similarities (99.7 and 90.52%, respectively). The complete genomes of these DHBV and 31 reference strains were analyzed using phylogenetic methods and classified into 3 clusters, which corresponded to the previously identified DHBV-I, DHBV-II, and DHBV-III branches. Recombination analyses of the 53 DHBV genomes indicated 2 major intergenotypic recombination events with high confidence values. These recombination events occurred between the genotypes of the Chinese isolates Y180813HB (Chinese branch [DHBV-Ⅰ]) and E170101AH (Chinese branch [DHBV-Ⅱ]) and the Western isolate DHBV-XY (Western branch [DHBV-Ⅲ]), resulting in the emergence of 2 Chinese recombinant isolates Y190303HN and Y170101HB. In addition, 40% (2/5) goose-origin and 58.8% (10/17) duck-origin DHBV in this study harbored the mutation site of G133E in preS, which promote the pathogenicity of DHBV. This is the first study to report on the genome analysis and recombination characterization of DHBV isolated from Chinese geese. Further, continuous investigation and molecular identification of DHBV should be conducted to attract researchers' attention.

An Improved TOPSIS Within the DEA Framework

Decision-maker (DM) can assign the weights of the distance measures in the relative closeness of technique for order preference by similarity to ideal solution (TOPSIS) for achieving his/her desirable ranking of alternatives. This phenomenon is called strategically setting distance measure weights in this study, which may affect the fairness of the results. In order to prevent this phenomenon, the idea of data envelopment analysis (DEA) is introduced to determine the objective weights of distance measures, and an improved TOPSIS is proposed in this study. The proposed method not only determines weights of the distance measures from an objective perspective and achieves the fully ranking of alternatives, but also provides the directions for improvement. Moreover, in comparison with the other methods, the advantages of the proposed method are analyzed, and the meanings and properties of the new relative closeness are discussed and proved. Finally, an example of evaluating the innovation development of high-tech industries in central and western regions of China is investigated to illustrate the effectiveness and the usefulness of the proposed method.

Digital Economy, Factor Allocation, and Sustainable Agricultural Development: The Perspective of Labor and Capital Misallocation

As an emerging economy, the combination of the digital economy and industrial development can lead to a variety of new industries and new formats and form new momentum. This paper aims to analyze how the digital economy affects sustainable agricultural development, through what path, and what role the factor allocation plays in this process. Based on the analysis of the impact mechanism of the digital economy on sustainable agricultural development, this paper takes 30 provinces in China from 2013 to 2020 as the research object, builds a panel data model and mediation effect model, empirical analyses on the impact of the digital economy on sustainable agricultural development, and verifies the mediation effect of factor allocation in this process. This study found that the digital economy significantly promoted sustainable agricultural development. At the national level, this obvious promotion effect was achieved by reducing the misallocation of labor and capital. At the regional level, sustainable agricultural development in the eastern region of China depended on the optimization effect of the digital economy on the allocation of labor and capital, but the situation was slightly different in the central and western regions of China. The digital economy in the central and western regions of China significantly improved sustainable agricultural development by allocation effect of labor factors. Although the allocation effect of capital factors had a positive effect on sustainable agricultural development, it was not significant. In order to promote sustainable agricultural development, the digital industry development should be accelerated, the allocation effect of the factor market should be brought into play, and the digital economy should be better integrated with sustainable agricultural development so as to realize the modernization of agricultural development.

Unmet need for postpartum family planning and influencing factors in China

To explore the rate and influencing factors of unmet need for postpartum family planning (PPFP) in China. We conducted a retrospective cohort study at 60 hospitals in 15 provinces that were in eastern, central, and western regions of China. Participants were women who delivered a live birth at the study sites with an interval of 13 to 24 months between delivery and interviews. We selected participants using cluster randomization approach, and the first 300 postpartum women who gave a birth at each study hospital after the initial month that had been selected were interviewed. Information on the women’s background characteristics, pregnancy history, time when menstruation and sexual activity resumed after childbirth, the adoption of contraceptive method, breastfeeding, and any pregnancy or pregnancy outcome after delivery were collected. We performed life-table analysis to estimate the rate of unmet need for PPFP and a 2-level logistic regression model to explore factors that influence unmet need for PPFP within the first 24 months postpartum. A total, 19,939 postpartum women were screened in this study, of which, 17,466 (87.6%) were eligible for this analysis. The rates of unmet needs for any FP methods were 23.9% (95% confidence interval [CI] 23.3–24.6%), 11.8% (95%CI 11.3–12.3%); 10.6% (95%CI 10.1–11.1%) at 6, 12, and 24 months postpartum; these rates for modern FP methods were 35.5% (95%CI 34.7–36.2%), 25.6% (95%CI 24.9–26.2%), and 24.6% (95%CI 23.9–25.2%), respectively. Results of 2-level logistic regression analysis showed that less-educated young women, those who had only one child or delivered by vaginal delivery at secondary hospitals, were associated with increased risk of unmet need for PPFP. Approximately 31% of women who had unmet need for PPFP reported a pregnancy during the first 24 months postpartum, which was significantly higher than the level for their counterparts (10.0%). The level of unmet need for PPFP in China was high, resulting in a high pregnancy rate within 24 months after delivery. Women’s age, education level, prior pregnancy and abortion histories, and delivery method were significantly associated with the risk of unmet need for PPFP. National PPFP guidelines that integrate PPFP services into prenatal and postnatal care are urgently needed and should be implemented throughout the country as soon as possible. PPFP services should promote the use of modern contraceptive methods.

The Growth of Service Sectors, Institutional Environment and Quality Development in China’s Manufacturing

The path of exploring the high-quality development of the manufacturing industry has become one of the focus issues in China. In terms of experience, the impact of service sector growth on the quality of China’s manufacturing industry is unclear. Therefore, institutional environment is incorporated in the research frame, and the Sys-GMM is used to estimate the relationship between them based on China’s provincial panel data from 2010 to 2020. The main results showed that: (1) Both the service sector growth and institutional environment can improve the quality of manufacturing development, and they have a significant interaction. (2) The impact of service sector growth on the quality of manufacturing industry decreases in the eastern, central and western regions of China. The expansion of foreign direct investment in services cannot significantly improve the quality development in China’s manufacturing, and there is no obvious interaction between SFDI and the institutional environment. However, the domestically funded service sector is the opposite. The main contribution of this paper is to empirically verify the impact of service sector growth on the quality of manufacturing development in China, and consider the differences in the impact of regional development of service sectors and the heterogeneity of investment subjects. In addition, from the perspective of system development, this article considers the influence of the institutional environment, so as to analyze the former’s impact on the latter in more detail.

Investigation of Spatiotemporal Variation and Drivers of Aerosol Optical Depth in China from 2010 to 2020

China has experienced rapid economic growth and serious control of aerosol emissions in the past decade. Thus, the spatiotemporal variations and driving factors of aerosol optical depth (AOD) are urgently needed to evaluate the effectiveness of aerosol control activities. The innovation of this study is a detailed spatial and temporal analysis of aerosol pollution in eight major regions of China from 2010 to 2020 using the MERRA-2 AOD reanalysis product and the driving mechanism based on the Granger causality test, sensitivity, and contribution analysis. The results show that the spatial distribution of AOD varied across the areas. Divided by the Hu Line, the AOD values of the Eastern areas were significantly higher than those of the Western areas. The temporal trend in the last eleven years was dominated by a continuous decline and moderate fluctuations at both annual and seasonal scales. The relationship between socioeconomic factors and AOD drivers was more significant in economically developed regions, suggesting that China pays more attention to haze control while developing its economy. The driving relationship between AOD and temperature was weak, while wind speed and relative humidity were more influential. For vegetation factors, Granger effects were mainly observed in the Northeast, Beijing-Tianjin-Hebei, Guangdong, Central China, and Southwest regions. In the Guangdong and Southwest regions, vegetation and economic factors were the more influential drivers. This study provides a scientific basis for the detection of aerosol changes, driving mechanisms and pollution management in China.

National Modern Agricultural Industrial Parks: Development Characteristics, Regional Differences, and Experience Inspiration—Case Study of 200 NMAIPs in China

Agricultural industries are the foundation of the modernization of agricultural and rural areas in China. National Modern Agricultural Industrial Parks (NMAIPs) provides a considerable nationwide platform for agricultural industries. We take 200 NMAIPs in China as objects. Through spatial analysis, the Herfindahl–Hirschman index, and the SBM-DEA model, we analyzed the development characteristics and regional differences of NMAIPs from the muti-level perspective of national planning, provincial coordination, and county implementation to propose policy recommendations aimed at sustainable and high-quality development. The results are as follows: (1) Regarding geospatial characteristics, NMAIPs are unevenly distributed, with a decreasing gradient from east to west. The direction is east (northward) to west (southward), consistent with the direction of the Hu line. The distribution density shows that the east is dense and the west is sparse. (2) For industrial concentration, the leading industries in NMAIPs tend to be homogenous. The HHI indicates that the homogenization of leading industries is widely represented in each province. The low oligopolistic areas are in the central and eastern regions of China, while the highly oligopolistic locations are in the western and northeastern provinces. (3) In inputs–outputs efficiency, the comprehensive technical efficiency is high but not optimal, while the distribution of values is high in the south and low in the north. Ten provinces are non-effective. According to inputs and outputs, the ineffective contribution of population of townships covered, occupied area and the capital from the collective economy are development barriers, and the high output value of NMAIPs cannot fully drive the employment and income of farmers. Further improvements are needed in terms of both pure technical efficiency and scale efficiency, and adjustments to scale operations should be in response to different returns to scale. Our research results provide policy recommendations for NMAIPs, including the establishment of a multi-level management mechanism, balancing regional development, diversifying and coordinating regional leading industries, and improving the efficiency of utilization factors.

Primary care providers' knowledge, attitudes, and practices related to prediabetes in China: A cross-sectional study.

The management of prediabetes has great clinical significance, and primary care providers (PCPs) play important roles in the management and prevention of diabetes in China. Nevertheless, little is known about PCPs' knowledge, attitudes, and practices (KAP) regarding prediabetes. This cross-sectional study aimed to assess the KAP regarding prediabetes among PCPs in the Central China region. This cross-sectional study was conducted using self-administered KAP questionnaires among PCPs from Central China region. In total, 720 PCPs completed the survey. Most physicians (85.8%) claimed to be aware of the adverse effects of prediabetes and reported positive attitudes toward prediabetes prevention, but the PCPs' knowledge of prediabetes and management practices showed substantial gaps. The prediabetes knowledge level and practice subscale scores of the PCPs were only 54.7% and 32.6%, respectively, of the corresponding optimal scores. Female PCPs showed higher prediabetes knowledge level scores (p = 0.04) and better practice scores (p = 0.038). Knowledge and attitude scores were inversely correlated with participants' age and duration of practice (p < 0.001). The PCPs who served in township hospitals had significantly higher knowledge and attitude scores than those who served in village clinics (p < 0.001). Furthermore, knowledge and practice scores increased with increasing professional titles. Recent continuing medical education (CME) attendance had a significant positive influence on knowledge of prediabetes (p = 0.029), but more than four-fifths of the surveyed PCPs did not participate in diabetes-related CME in the past year. Substantial gaps were observed in PCPs' knowledge and practices regarding prediabetes in the Central China region. CME programmes were under-utilized by PCPs. Structured programmes are required to improve PCPs' prediabetes-related knowledge and practices in China.

Geostatistical and geoarchaeological study of Holocene floodplains and site distributions on the Sha‐Ying River Basin, Central China

AbstractGeostatistics has become a powerful method for investigating complex spatial variations of prehistoric settlements in floodplains and other geomorphological settings. A geoarchaeological drilling program that covers most of the Sha‐Ying River Basin provides a rare opportunity with unusually detailed environmental data to contest and develop the geostatistics method, which proves to be essential, in combination with archaeological data, to understand long‐term (9000–2500 B.P.) patterns of human inhabitation and adaption to volatile floodplain environments in eastern Central China. We analysed the variography and multivariate ordination of the borehole data and explored the complexities of landform evolution, with reference to sedimentation processes and soil development in the floodplain of the Sha‐Ying River. The recurrent impact of river floods on regional landforms is manifested by spatial‐autocorrelated properties over distances up to 10 km, sometimes with directional trends. We then developed a model of landform evolution through kriging and compared the model with detailed reconstruction of archaeological settlement patterns. Our results illustrate long‐term socio‐environmental dynamics by which human communities first populated and then adapted in diverse ways to the changing floodplain environments from the early to middle Holocene. This improved method will have far‐reaching implications for future studies on similar geomorphological settings across vast floodplains of Central China and other global regions.

Spatial Heterogeneity and Regional Clustering of Factors Influencing Chinese Adolescents’ Physical Fitness

There is often significant spatial heterogeneity in the factors influencing physical fitness in adolescents, yet less attention has been paid to this in established studies. Based on the 2018 Chinese National Student Physical Fitness Standard Test data, this study uses a multi-scale, geographically weighted regression (MGWR) model combined with a K-means clustering algorithm to construct a spatial regression model of the factors influencing adolescent physical fitness, and to investigate the degree of spatial variation in the physical fitness of Chinese adolescents from a socio-ecological perspective of health promotion. The following conclusions were drawn: the performance of the youth physical fitness regression model was significantly improved after taking spatial scale and heterogeneity into account. At the provincial scale, the non-farm output, average altitude, and precipitation of each region were strongly related to youth physical fitness, and each influencing factor generally showed a banded spatial heterogeneity pattern, which can be summarized into four types: N-S, E-W, NE-SW, and SE-NW. From the perspective of youth physical fitness, China can be divided into three regions of influence: the socio-economic-influenced region, mainly including the eastern region and some of the central provinces of China; the natural-environment-influenced region, which mainly includes the northwestern part of China and some provinces in the highland region; and the multi-factor joint-influenced region, which mainly includes the provinces in the central and northeastern regions of China. Finally, this study provides syndemic suggestions for physical fitness and health promotion for youths in each region.

MaxEnt Modeling for Predicting Suitable Habitat for Endangered Tree Keteleeria davidiana (Pinaceae) in China

Understanding species response to climate change is essential for the conservation and utilization of species resources under rapid climate change in the future. In this study, the present and future suitable distribution range of Keteleeria davidiana, a tertiary relict gymnosperm, was predicted based on the maximum entropy model (MaxEnt). A total of 158 occurrence records were collected after removing the duplicated records. Six low-correlation climate variables were used to predict species distributions. The three key climate factors that affect the distribution of K. davidiana were temperature seasonality (34.96%), mean temperature of the coldest quarter (28.30%) and precipitation seasonality (13.58%). The most suitable zone of the temperature seasonality for K. davidiana was between 377.4 and 843.4. The highly suitable area was located in the mountainous regions of central and southeast China, which accounted for 13.39% of the whole study area. With climate warming in the future, the highly suitable distribution area of K. davidiana was estimated to decrease by 35% (SSP1-2.6 scenario) or 85% (SSP5-8.5 scenario). This study has provided a sufficient scientific basis for the future in situ and ex situ conservation of K. davidiana.

Spatio-Temporal Evolution of Agricultural Carbon Emissions in China, 2000–2020

Agricultural carbon mitigation is one of the most important components of China’s carbon mitigation goals. This paper calculates China’s agricultural carbon emissions (ACEs) from 2000 to 2020, studies the spatio-temporal evolution characteristics of China’s ACEs, and aims to provide references for the development of China’s ACEs reduction policies. The results show that the total ACEs in China presented an inverted “W” trend, with a slight increase of 2.81% in total. China’s ACEs mainly came from livestock and poultry breeding and agricultural material inputs. Although the carbon emissions from rice cultivation and soil accounted for a relatively low proportion, they showed an uptrend of fluctuation during the study period. From a geographical point of view, ACEs in the regions of central China and western China were relatively high compared to those in eastern China. Carbon emissions decreased for crop farming and livestock and poultry breeding in most eastern provinces. Crop farming carbon emissions grew, while the emissions from livestock and poultry breeding declined in most of the central provinces. Carbon emissions increased for crop farming and livestock and poultry breeding in most western provinces. Therefore, the existing low-carbon agricultural policies should be optimized, crop farming technologies should be improved, and specific policies should be applied in the corresponding regions to support China’s ACEs reduction.

Provenances of the Oldest Xiashu loess and Xuancheng loess in southern China: Implications for dust transport and dust proxies of the East Asian winter monsoon

The loess-paleosol sequences of southern China are valuable paleoclimatic archives since the Middle Pleistocene, on the regional and global scales. Knowledge of loess provenance can shed light on dust transport and the development of paleoclimatic proxies for loess deposits. However, there is a research gap regarding the provenance of the Oldest (∼0.9 Ma) Xiashu loess near the Yangtze River valley. The precise source area of the Xuancheng loess in southern China remains to be unidentified. In this study, we used elemental geochemistry and detrital zircon UPb ages to identify the sources of the Oldest Xiashu loess and Xuancheng loess in southern China. The Oldest Xiashu loess is dominantly derived from Yangtze River sediments, and part of its fine-grained dust component originates from the arid regions of Central Asia or northern China. The elemental compositions of the size-fractionated silicates and detrital zircon UPb ages of the Xuancheng loess are like those of the Shuiyang River sediments in the Xuancheng region. These results demonstrate that the Xuancheng loess is mainly the product of local dust activity in the Xuancheng regions, and thus that the Xiashu and Xuancheng loess are the products of independent dust transport processes. This spatial differentiation of loess provenance may be a widespread phenomenon in southern China, and consequently, the grain size compositions of the various loess sections in southern China cannot be used to recover paleo-wind directions on a regional scale. Overall, our study shows that when the grain size compositions from the southern China loess are used to reconstruct East Asian winter monsoon intensity, the signals from local wind fields should first be removed.

The Impact of Government Transfer Payments on Extracurricular Tuition Expenditure for Children in Urban China

This article uses 2012–18 China Family Panel Survey (CFPS) panel data to study the impact of government transfer payment receipt on extracurricular tuition expenditure for children of urban families requiring aid. Findings have shown that government transfer payments increase extracurricular tuition spending for children and have a positive impact on total family expenditure with regard to children's education. Heterogeneity tests indicate that the impact is significant in the central and eastern regions of China, among children above seven years old and children in one-child families. The authors attribute the positive effects to parents' increased awareness of the importance of education and to increased opportunities for children from assisted families to participate in extracurricular tuition classes. This article proposes policy recommendations to improve the government transfer payment system in urban China.

The Impact of Green Finance on Export Technology Complexity: Evidence from China

With the improvement of the technology level and the prevalence of the concept of environmental protection, green finance has been gradually applied to the field of production and economic development. As an important measure of economic development, the export sector is inevitably affected by the development of green finance. However, using the high technology of exports to analyze the relationship between green finance and exports has not drawn much attention. Based on the panel data from 30 provinces in China from 2011 to 2020, this study empirically examined the impact of green finance as well as export technology complexity, by using a combination of fixed effects and mechanism analysis. The results show that green finance has a significantly positive impact on export technology complexity, which means that an increase in the depth of green finance can improve export product quality. In terms of regional heterogeneity, the impact of green finance on the high technology of exports is greater in the eastern region than in the central and western regions of China. In terms of the manifestation of green finance, the effect of green bonds on export technology complexity is greater than that of green investment and insurance. Green finance improves the export technical complexity through three intermediaries, such as green technology innovation, capital investment strength, and product upgrading capacity. This study highlights the importance of green finance and provides new methods for governments to assist in the formulation of policies that can improve export technology complexity.

Is tourism effective in mitigating the shadow economy in developing countries? Evidence from China

ABSTRACT Recent studies found that tourism can mitigate the shadow economy, but its effectiveness in a specific country remains uncertain. To fill the research gap, this study investigates the relationship between tourism and the shadow economy in China based on province level data for 2000-2016. The results reveal that the shadow economy will be adversely affected by tourism. Moreover, regional heterogeneity analysis indicates that in central and western regions of China, tourism is more effective in suppressing shadow activities. The findings contribute to a policy reference for mitigating the shadow economy and regulating tourism development.

Does Government Purchasing Science and Technology Public Service Promote Regional S&amp;T Innovation Ability? Evidence from China

During the development of scientific and technological innovation, the importance of Government Purchasing Public Services (GPPS) in the field of science and technology (S&amp;T) has become increasingly prominent. To investigate the relationship between Government Purchasing Science and Technology Public Services (GPSTPS) and regional S&amp;T innovation ability, this paper first constructs a PMC index model to estimate GPSTPS objectively. Then, the spatial econometric model is adopted to explore the impact of GPSTPS policy on the regional S&amp;T innovation ability based on the provincial panel data from 2008 to 2017 in China. Results show that: (1) Regional S&amp;T innovation ability has a significant spatial positive correlation in geographical space from 2008 to 2017. (2) From the overall perspective, the GPSTPS policy does not play a role in improving the regional S&amp;T innovation ability. (3) From the perspective of subregions, there are differences in the impact of GPSTPS on the regional S&amp;T innovation ability between the eastern, central and western regions of China. (4) From the perspective of spatial spillover effect, the policy of GPSTPS has a positive spatial spillover effect on the improvement of regional S&amp;T innovation ability in the eastern region, while the effect is not obvious in central and western regions.

Analysis of spatial and temporal characteristics of carbon emission efficiency of pig farming and the influencing factors in China.

Pig farming has been a crucial contribution to China's food security although intestinal fermentation and its excrement during pig breeding are major sources of greenhouse gas emissions. In this paper, we measured the carbon emission efficiency of pig farming in 30 provinces (autonomous regions and municipalities) from 2010 to 2020 by using the non-expected output Slack-Based Measure (SBM) model and analyzed the spatial characteristics of the carbon emission efficiency of pig farming in China. We also examined and analyzed the factors influencing the carbon emission efficiency of pig farming by using the limited dependent variable model (Tobit). The results show that: the carbon emission efficiency of pig farming in China shows an M-shaped upward trend over time by comparing the carbon emission efficiency longitudinally during the study period and the carbon emission efficiency of pig farming shows a decreasing trend in the east, central and west regions of China by comparing the carbon emission efficiency of different regions horizontally. It's also shown that regions with low- and extremely-low-efficiency transfer from the east to the central and west regions and the central and regions with high-efficiency transfer to the east. The regression analysis of the factors influencing the carbon emission efficiency of pig breeding shows that the comparative advantage of the pig industry and transportation accessibility is positively correlated with the carbon emission efficiency of pig breeding, whereas the proportion of food resources and market scale is negatively correlated with the carbon emission efficiency of pig breeding. At the same time, the production layout index has no significant influence on the carbon emission efficiency of pig breeding. The research results provide a theoretical basis for regional differentiation of carbon emission management from pig farming, optimizing the layout of the pig industry and reducing environmental pollution.

Policy Impacts of High-Standard Farmland Construction on Agricultural Sustainability: Total Factor Productivity-Based Analysis

High-standard farmland construction is an important initiative in China that promotes sustainable agricultural development and ensures food security through land consolidation. This study measures the growth of agricultural total factor productivity (ATFP) in China, which is used to characterize the sustainable development of agriculture. Using provincial panel data from China and a continuous difference-in-difference (DID) model, the study examines the impact of high-standard farmland construction policy on ATFP growth. Results show that ATFP in China has an increasing trend with an average annual growth rate of 3.6%. The average enhancement effect of high-standard farmland construction policy on ATFP is 1.0%, which remains significant after various robustness tests. The positive effect of the policy on ATFP becomes apparent in the third year of implementation and shows a gradually increasing trend. The study also finds that the impact of high-standard farmland construction on ATFP is more pronounced in the central regions of China, the main grain-producing regions, and the regions with higher ATFP. High-standard farmland construction policy enhances ATFP by promoting agricultural technology change and technical efficiency. To promote the growth of ATFP and achieve sustainable agricultural development, China should continue to promote the construction of high-standard farmland and explore suitable construction models for different regions.

Temporal-Spatial Evolution and Trend Prediction of the Supply Efficiency of Primary Medical Health Service-An Empirical Study Based on Central and Western Regions of China.

China has established a comprehensive primary medical health service system, but the development of primary medical health services in the central and western regions is still unbalanced and insufficient. Based on data from 2010 to 2019, this paper constructs a super efficiency Slack-Based Measure model to calculate the supply efficiency of primary medical health services in 20 provinces and cities in central and western China. Using Kernel density estimation and Markov chain analysis, this paper further analyzes the spatial-temporal evolution of the supply efficiency of primary medical health services in central and western China, and also predicts the future development distribution through the limiting distribution of Markov chain to provide a theoretical basis for promoting the sinking of high-quality medical resources to the primary level. The results show that firstly, during the observation period, the center of the Kernel density curve moves to the left, and the main peak value decreases continuously. The main diagonal elements of the traditional Markov transition probability matrix are 0.7872, 0.5172, 0.8353, and 0.7368 respectively, which are significantly larger than other elements. Secondly, when adjacent to low state and high state, it will develop into convergence distributions of 0.7251 and 0.8243. The supply efficiency of primary medical health services in central and western China has the characteristics of high (Ningxia) and low (Shaanxi) aggregation respectively, but the aggregation trend is weakened. Thirdly, the supply efficiency of health services has the stability of keeping its own state unchanged, but the transition of state can still occur. The long-term development of the current trend cannot break the distribution characteristics of the high and low clusters, the efficiency will show a downward trend in the next 10-20 years, and still the problem of uneven long-term development emerges.