Türkiye’de sağlık göstergelerine dayalı bölgesel kümeleme analizlerine ilişkin kapsamlı bir derleme

Öz

Arka Plan—Sağlık göstergelerinin ulusal ve uluslararası düzeylerde karşılaştırmalı olarak analiz edilmesi, bölgesel farklılıkların belirlenmesi ve sağlık hizmetlerine erişim, kalite, kapasite ve sonuçlar bakımından ortaya çıkan farklılıkların değerlendirilmesi açısından önemlidir. Kümeleme analizi, benzer sağlık profillerine sahip bölgeleri gruplandırmak ve kanıta dayalı bölgesel sağlık planlamasını desteklemek amacıyla yaygın olarak kullanılmaktadır. Türkiye’de sağlık göstergelerine ilişkin bölgesel eşitsizlikler devam etmekle birlikte, bu alandaki çalışmalar kapsam ve yöntem bakımından bütüncül olmayan bir görünüm sergilemektedir. Artan veri erişilebilirliği ve analitik kapasiteye rağmen, Türkiye’de sağlık göstergelerine dayalı bölgesel kümeleme çalışmalarını inceleyen kapsamlı bir derleme bulunmamaktadır. Bu nedenle, alandaki yöntemsel eğilimleri, yaygın uygulamaları ve çözüm bekleyen boşlukları ortaya koymak ve mevcut literatürün bölgesel sağlık politikalarının geliştirilmesine nasıl katkı sağladığını değerlendirmek için yapılandırılmış bir senteze ihtiyaç duyulmaktadır.

Amaç—Bu çalışmanın amacı, Türkiye’de sağlık göstergelerine dayalı bölgesel kümeleme çalışmalarına ilişkin ilk kapsamlı derlemeyi sunmaktır. Derleme, gelecekteki araştırma yönelimlerine ışık tutmayı ve politika yapıcıların veri temelli ve bölgesel hedefli sağlık stratejileri geliştirmelerine yardımcı olmayı amaçlamaktadır. Çalışmanın temel katkısı, mevcut literatürün derlenmesi, düzenlenmesi ve eleştirel olarak analiz edilmesinin yanı sıra, gelecekteki çalışmalara yön verecek araştırma boşluklarının belirlenmesidir.

Yöntem—Türkiye’de il ve bölgelerin sağlık göstergelerine göre kümelenmesini ele alan çalışmaları belirlemek amacıyla kapsamlı bir derleme gerçekleştirilmiştir. Mart 2026’ya kadar yayımlanan literatür, kümeleme analizi ve sağlık göstergeleriyle ilişkili İngilizce ve Türkçe anahtar kelimeler kullanılarak birden fazla veri tabanından taranmıştır. Başlıklar, özetler ve anahtar kelimeler Boole operatörleri kullanılarak incelenmiş, gerekli durumlarda tam metinler değerlendirilmiştir. Derleme kapsamında yayın eğilimleri, seçilen sağlık göstergeleri, coğrafi kapsam, veri ön işleme uygulamaları, kümeleme teknikleri, küme sayısını belirlemek için kullanılan yöntemler, küme değerlendirme yaklaşımları, veri kaynakları, kullanılan veri yılları ve yazılım araçları incelenmiştir.

Bulgular—Son yıllarda çalışma sayısında belirgin bir artış görülmesine rağmen, literatürün genel hacmi Türkiye’deki bölgesel sağlık eşitsizliklerinin politika açısından taşıdığı önemle karşılaştırıldığında sınırlı kalmaktadır. İncelenen çalışmaların, özellikle Ward yöntemi ve k-ortalamalar gibi sınırlı sayıdaki geleneksel kümeleme yöntemleri etrafında yoğunlaştığı görülmüştür. Buna karşın, gösterge seçimi çalışmalar arasında önemli ölçüde farklılık göstermekte ve tam olarak standartlaştırılmış bir yaklaşıma dayanmamaktadır. Veri ön işleme, doğrulama ve sağlamlık analizlerine ilişkin yöntemsel uygulamaların da incelenen literatürde tutarsız biçimde raporlandığı belirlenmiştir.

Sonuç—Bu derleme, literatürün kademeli olarak büyümesine rağmen yöntemsel açıdan belirli yaklaşımlar etrafında yoğunlaşmaya devam ettiğini göstermektedir. Bölgesel sağlık analizlerinin analitik sağlamlığını güçlendirmek ve politika açısından uygulanabilirliğini artırmak için daha fazla yöntemsel çeşitliliğe ihtiyaç vardır. Gelecekteki çalışmaların daha gelişmiş kümeleme yöntemlerini benimsemesi, boylamsal ve tahmine dayalı yaklaşımları içermesi, daha geniş veri kaynaklarını entegre etmesi ve disiplinler arası iş birliğini güçlendirmesi gerekmektedir. Bu iyileştirmeler, bölgesel sağlık eşitsizliklerinin daha güvenilir biçimde değerlendirilmesini destekleyebilir ve Türkiye’de daha adil sağlık planlamasına katkı sağlayabilir.

Anahtar Kelimeler

• Kümeleme analizi
• Sağlık eşitsizlikleri
• Sağlık göstergeleri
• Literatür derlemesi
• Bölgesel analiz
• Türkiye

A comprehensive review of regional clustering analyses based on health indicators in Türkiye

Öz

Context—Comparative analysis of health indicators at national and international levels is essential for identifying regional disparities and evaluating differences in healthcare access, quality, capacity, and outcomes. Clustering analysis is widely used to group regions with similar health profiles and to support evidence-based regional health planning. In Türkiye, regional inequalities in health indicators persist, yet related studies remain fragmented in scope and methodology. Despite increasing data availability and analytical capacity, no comprehensive review has examined studies on regional clustering based on health indicators in Türkiye. A structured synthesis is therefore needed to clarify methodological trends, dominant practices, and unresolved gaps in this field, and to assess how the existing literature contributes to regional health policy development.

Objective—The objective of this study is to present the first comprehensive review of regional clustering studies in Türkiye based on health indicators. The review aims to inform future research directions and assist policymakers in developing data-driven and regionally targeted healthcare strategies. Its main contribution is the compilation, organization, and critical analysis of the current literature, as well as the identification of research gaps to guide future studies.

Method—A comprehensive review was conducted to identify studies on the clustering of provinces and regions in Türkiye based on health indicators. Literature published up to March 2026 was retrieved from multiple databases using English and Turkish keywords related to cluster analysis and health indicators. Titles, abstracts, and keywords were searched using Boolean combinations, and full texts were examined when necessary. The review examined publication trends, selected health indicators, geographical coverage, data preprocessing practices, clustering techniques, methods used to determine the number of clusters, cluster evaluation approaches, data sources, years of data used, and software tools.

Results—Although the number of studies has increased notably in recent years, the overall volume of the literature remains limited relative to the policy importance of regional health inequalities in Türkiye. The reviewed studies were concentrated around a small set of conventional clustering methods, particularly Ward’s method and k-means, whereas indicator selection varied substantially across studies and was not based on a fully standardized approach. Methodological practices related to preprocessing, validation, and robustness were also reported unevenly in the reviewed literature.

Conclusion—This review shows that the literature remains methodologically concentrated despite its gradual growth. Greater methodological diversity is needed to strengthen analytical robustness and improve the policy relevance of regional health analyses. Future studies should adopt more advanced clustering methods, incorporate longitudinal and predictive approaches, integrate broader data sources, and strengthen interdisciplinary collaboration. These improvements may support more reliable assessments of regional health inequalities and contribute to more equitable healthcare planning in Türkiye.

Anahtar Kelimeler

• Clustering analysis
• Health disparities
• Health indicators
• Literature review
• Regional analysis
• Türkiye

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