Life-Cycle Carbon Emissions and Carbon-Neutrality Pathways of Hospital Buildings: Evidence from Shenzhen, China

Hospital buildings (HBs) are among the most energy-intensive public buildings, yet their life-cycle carbon characteristics, emission drivers, and long-term mitigation potential remain insufficiently quantified. This study establishes a comprehensive life-cycle carbon assessment framework for HBs based on life cycle assessment (LCA), using a Grade-A tertiary hospital in Shenzhen, China, as a case study. The framework quantifies carbon emissions across the materialization, operation, and demolition stages, and estimates operational emissions from public hospital buildings at the city scale. Logarithmic Mean Divisia Index (LMDI) decomposition and Long-range Energy Alternatives Planning (LEAP) modeling were subsequently applied to identify historical drivers and evaluate future mitigation pathways. The results show that the case hospital generated approximately 0.57 Mt CO2e of gross life-cycle carbon emissions over a 50-year service life, with the operational stage dominating approximately 88% of net emissions. Electricity consumption accounted for 94% of operational energy-related emissions, while HVAC systems and the Diagnostic departments were identified as major carbon hotspots. At the city scale, the gross operational emissions of 73 public hospitals in Shenzhen were estimated at approximately 0.74 Mt CO2e in 2020 within the defined accounting boundary. For the broader citywide hospital sector, LMDI analysis revealed that annual operational emissions increased from approximately 0.25 Mt CO2e in 2006 to 0.91 Mt CO2e in 2020, primarily driven by healthcare service demand and hospital infrastructure expansion, whereas the declining operational carbon emission coefficient provided a partial offset. LEAP scenario analysis further demonstrated that net operational emissions peaked in 2050 under BS and in 2030 under SI and SII. Under SIII, emissions declined continuously from the 2020 base-year level to approximately 0.29 Mt CO2e in 2060, representing a reduction of approximately 68%. These findings highlight the necessity of coordinate building energy optimization, healthcare infrastructure development, and energy system decarbonization for low-carbon transformation of hospital buildings.