Original Articles Open access

Spatial equity in healthcare accessibility for ageing populations: an enhanced two-step floating catchment area analysis in Antalya, Türkiye

Authors

Published
12 November 2026
Section
Original Articles
DOI
10.4081/gh.2026.1533

Abstract

Conventional spatial accessibility metrics treat the population aged 65 years and over as homogeneous, despite well-documented declines in mobility across age sub-groups that may conceal disadvantage affecting the oldest-old. This cross-sectional ecological study quantified age-stratified inequality in healthcare accessibility across the 19 districts of Antalya province, Turkey. An age-stratified, topographically-adjusted enhanced two-step floating catchment area (AT-E2SFCA) method was developed, incorporating age-specific catchment parameters for sub-groups aged 65–74, 75–84 and 85 years and over; decoupled sub-models for acute (hospital) and preventive (primary care) services; and a topographic correction of effective travel distance. Data on 44 hospitals, 295 family health centres, 17 dialysis centres, 8 oncology centres and 920 pharmacies were obtained from official registries. Inequality was assessed using Gini coefficients, global Moran's I and Local Indicators of Spatial Association (LISA); sensitivity analyses addressed both catchment parameters and the topographic correction. Aggregate measures for those aged 65 and over underestimated inequality affecting the oldest-old by 34% for acute care and 49% for preventive care. The acute Gini coefficient rose from 0.262 (aged 65–74) to 0.362 (aged 85 and over), approaching severe inequality, whereas the aggregate composite (0.271) remained moderate. Acute and preventive disadvantage patterns were partially independent. LISA identified a high-accessibility urban core and peripheral low-access districts. A 150-bed hospital scenario was equity-neutral and locally beneficial, whereas a 250-bed expansion mildly worsened inequality by concentrating capacity. Age-disaggregated, service-decoupled accessibility metrics are essential for equity-focused geriatric health planning; strategic facility siting, rather than undifferentiated capacity expansion, drives equity gains.

Keywords

Ethics Approval

Not applicable.

Supporting Agencies

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data Availability Statement

All data are publicly available (TÜİK: https://data.tuik.gov.tr; Antalya Provincial Health Directorate: https://antalyaism.saglik.gov.tr). Analysis code and processed datasets are openly available at Zenodo: https://doi.org/10.5281/zenodo.21427039.

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