ArticleInternational journal of health geographics2026
Merging geographic regions for the analysis of the cardiological rehabilitation care system in Hungary.
Article in International journal of health geographics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIdentifying spatial patterns or anomalies in medical care related administrative data is a valuable asset to plan the care system. However, the applicability of any results depends on the statistical robustness and spatial resolution of the analysis.
methodsThis study proposes a new method for designing the spatial units for a country-wide analysis, based on the iterative merging of the postal code areas. The method aims to find a trade-off between fine spatial resolution and districts with a statistically relevant number of episodes, also considering the homogeneity of the districts. The method is applied for the spatial analysis of the cardiological rehabilitation care system in Hungary over an 8-year-long period, with the cardiological rehabilitation rate (RR) after acute cardiac events as the dependent variable. We consider two cardiological episode types and perform two separate analyses throughout the study. A voting scheme is used to define the de facto service areas of the dominant providers. Homogeneous spatial clusters with high and low RR values are compared to the boundaries of the service areas using spatial correlation.
resultsThe proposed merging method can provide a significantly finer resolution than a simple spatial approach, and the border zones become thinner and clearer between contiguous de facto dominant providers. The spatial analysis found strong clustering with a global Moran I index of 0.80 and 0.85, respectively, and very large regional differences, especially in rural areas of the country, which is consistent with inequities in access or referral pathways. The boundaries of rehabilitation rate anomalies generally match with the dominant service areas of the dominant providers, suggesting that the differences are linked with the anomalies in the professional practice of the providers.
conclusionsThe proposed method proved a useful tool for the spatial analysis of the cardiological rehabilitation network. The method is not specific to the local culture, and it is directly applicable in any other healthcare domain with several service providers and for which population-level, geographically referenced data is available. More research using more elaborate data sources would be needed to understand the root causes of the anomalies detected in the study.
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