The turnover challenge in China’s Centers for Disease Control and Prevention: Role of salaries, job satisfaction and burnout

Background. As a core pillar in China’s public health system, Centers for Disease Control and Prevention (CDCs) face significant workforce turnover. Our study addresses two gaps: the structural relationships and combined effect on CDC turnover of salary, job satisfaction, and burnout, and, second, the inter-relationship of marital status and these factors. Methods. A cross-sectional survey was conducted across all CDCs in Yunnan Province, China (March-April 2024), collecting data on salary, job satisfaction, burnout, turnover intention, and sociodemographic information. Chained mediation models analyzed the multiple mediating effects of job satisfaction and burnout between salary and turnover intention. Results. Lower salary directly correlated with higher turnover intention (β = -0.059, P < 0.05), accounting for 42.14% of the total effect. Job satisfaction and burnout demonstrated significant chained mediation between salary and turnover intention. Job satisfaction also exerted an independent mediating effect (β = -0.058, P < 0.01), while burnout did not. The total indirect effect coefficient was − 0.081, constituting 57.86% of the total effect. Married staff mirrored the full-sample pathways, though effect sizes differed. Unmarried staff reported significantly higher burnout than married staff (6.94 vs. 6.31, P < 0.01), but showed no significant associations between salary and job satisfaction, burnout, or turnover intention. Conclusions. Job satisfaction and burnout served as chained mediators between salaries and turnover intentions, with job satisfaction exerting an additional independent mediating effect. Internal heterogeneity was revealed within the marriage subgroups. Interventions should prioritize equitable compensation, enhance job satisfaction, reduce burnout, and implement differentiated measures to reduce workforce turnover.