Spatial Accessibility of Automated External Defibrillator Services in High-Density Older-Adult Areas: A Geographic...

We aimed to evaluate the accessibility and equity of automated external defibrillators (AEDs) in areas with a high concentration of older adults and to propose evidence-based policy directions using geographic information systems (GIS).

For the secondary analysis, multiple datasets were integrated from Korea's National Geographic Information Institute, Ministry of the Interior and Safety, Suwon Fire Department, and Suwon Southern Fire Station, including continuous digital topographic maps, demographic statistics, AED locations, road networks, and out-of-hospital cardiac arrest incidence data. The clustering and spatial heterogeneity of AED deployment were examined using kernel density estimation and spatial autocorrelation analysis. Service areas reflecting the walking speeds of older adults were delineated, and equity was assessed using the Gini coefficient. Two-step floating catchment area analysis provided supply-to-demand ratios and accessibility indices.

AEDs exhibited clustered patterns centered on public locations, and several areas were identified as potential service blind spots, revealing inequities at the neighborhood level. Several AED sites were insufficient for the local older-adult population, and only a subset of the areas demonstrated relatively high accessibility indices.

As the population age structure shifts toward older age groups, AED policy criteria should be redesigned to reflect the mobility and accessibility of older adults. Implementing mixed relocation strategies that incorporate age-friendly criteria, conducting periodic policy performance evaluations, and enhancing AED visibility and tailored education that accounts for the cognitive characteristics of older adults will contribute to improving the health of older populations.