Clustering Portuguese municipalities based on population health indicators

Abstract Background The large number of publicly available health-related indicators poses challenges in health planning to policymakers. Identifying patterns among municipalities may assist these processes, by grouping similar contexts and pointing out relevant differences among neighbouring locations. The aim of this work was to define clusters of municipalities based on health-related indicators. Methods All health-related indicators available at municipality level for the year 2021 were obtained from the Portuguese National Statistics Office website. Missing values were imputed with the closest available year or excluded. Indicators were standardized and K-means clustering was applied. Elbow criterion was used to select the optimal number of clusters. Sensitivity analysis was performed with a priori exclusion of indicators less directly associated with health outcomes. Results The clustering analysis revealed five distinct clusters of municipalities. Clusters were associated with specific socio-demographic patterns, providing insights into common health challenges and strengths within each group. Interestingly, geographic profiles emerged (e.g. coastal vs inland), despite no geographic information being specifically provided. One outlier municipality was identified (Lisbon), highlighting a need for special consideration. Conclusions Clustering techniques provide a data-driven approach to inform public health planning. Our findings show previously unrecognized patterns and relationships between municipalities. Using these clusters, policymakers may implement interventions based on what has been proven to work in similar contexts, enhance collaboration opportunities and promote a tailored policy development, contributing to an overall improvement of public health outcomes. Key messages • Clustering machine learning techniques provide a data-driven approach to inform public health planning. • Identifying comparable municipalities based on health-related indicators allows targeted public health interventions.