Age structure alters optimal hospital allocation for reducing tuberculosis fatalities in South Korea

Abstract

Optimal healthcare allocation requires accounting for spatial heterogeneity in disease burden, while demographic heterogeneity may further alter local vulnerability when outcomes vary strongly with age. Tuberculosis (TB) provides a useful case because treatment requires sustained access to care and fatality risk rises markedly with age. In South Korea, TB incidence remains relatively high, while regional incidence, mortality, and hospital data are systematically recorded, allowing these effects to be examined empirically. Finer spatial resolution provides more local observations, helping reveal regional heterogeneity and spatial patterns. However, due to privacy concerns, official district-level TB statistics are provided only in age-aggregated form, whereas age-specific statistics are available at province level. We therefore propose a method to reconstruct age-resolved TB cases and fatalities across 228 districts for 2014--2022 by combining province-level age distributions with district-level totals, using the finest available age and spatial information. Building on an existing hospital-allocation framework, we incorporate age-dependent vulnerability into the fatality-minimization objective. We find that age-aware and age-agnostic optimizations yield similar total minimized fatalities but distinct district-level allocations. The oldest age group's rescaled patient density is strongly associated with this difference and the direction of hospital redistribution. Age-weighting schemes clarify how countervailing contributions across age groups affect optimization.

15 pages, 10 figures