a decreasing trendP < 0.001
Monthly number of reported drug shortages The monthly occurrence of all drug shortages in the 258 cities showed a decreasing trend of 20.6%, from 2655 times in January 2018 to 2109 times in December 2020 (z-statistic (Z) = -3.83; P < 0.001) ( Figure 1 , panel A; Table S2 in the Online Supplementary Document ).