Speaker
Description
Spatial accessibility to healthcare can influence population health outcomes during large-scale public health crises. However, its contribution to excess mortality beyond directly reported COVID-19 deaths remains insufficiently quantified. This study evaluates the relationship between regional healthcare accessibility and excess mortality across South Korea during the COVID-19 pandemic.
Regions were grouped using hierarchical clustering based on average travel time to medical facilities, producing high- and low-accessibility clusters. A counterfactual mortality baseline was estimated using a machine-learning prediction model trained on pre-pandemic mortality data from 2014–2019. Excess mortality during the pandemic period (2020–2022) was calculated as the difference between observed and predicted deaths. The association between accessibility and excess mortality was then assessed using multiple linear regression.
Regions with lower healthcare accessibility showed substantially higher excess mortality, particularly during the Omicron wave when healthcare demand was highest. In high-accessibility regions, excess mortality largely aligned with reported COVID-19 deaths, whereas low-accessibility regions exhibited additional excess mortality not explained by COVID-19 fatalities. These findings highlight how spatial healthcare accessibility may amplify indirect mortality during pandemics.
