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Purpose <p>This study examines geographical distribution of depression recognized in primary versus secondary care across Danish municipalities and the association between municipality-level socioeconomic indicators and depression.</p> Methods <p>The study was based on data from the Danish registers. We followed ~ 5,5&#xa0;million individuals aged &gt; 18 years during the period 2012–2023 for antidepressant prescriptions (reflecting primary care) or hospital-recorded depression diagnoses (reflecting secondary care). Hazard ratios (HR) of (1) antidepressants and hospital diagnoses across municipalities and (2) antidepressants and hospital diagnoses across four municipality-level socioeconomic indicators, were calculated. Lee’s L statistics were applied to assess spatial associations and median hazard ratios were estimated as a measure of between-municipality variation.</p> Results <p>We found an overall positive spatial association between the two outcomes. Most municipality-level indicators were associated with higher antidepressant prescription rates, after adjustment for individual factors, strongest for high proportions of short education and transfer payments (HR 1.16 (95% CI 1.10-1.23 and 1.17 (95% CI 1.10-1.23), respectively). Associations with hospital-recorded depression were largely attenuated, after adjustment for individual factors. Between-municipality variation was modest (MHR 1.14 for antidepressant prescriptions and 1.19 for depressions diagnoses).</p> Conclusion <p>We showed that municipalities with socioeconomic disadvantage had higher rates of antidepressant prescriptions. However, a large part of the between-municipality variation remains unexplained, highlighting the need to address contextual determinants beyond individual-level factors, even within a universal healthcare system.</p>

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Geographical variation and area-level socioeconomic disadvantage in recognized depression: A nationwide register-based Danish cohort study

  • 期刊论文

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  • 发表日期：

    2026年4月29日

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  • M. B. Raft,
  • T. S. H. Jørgensen,
  • J. Renneberg,
  • C. F. Lassen,
  • R. K. Jacobsen,
  • A. Jorgensen,
  • M. B. Jørgensen,
  • M. Osler

摘要

Purpose

This study examines geographical distribution of depression recognized in primary versus secondary care across Danish municipalities and the association between municipality-level socioeconomic indicators and depression.

Methods

The study was based on data from the Danish registers. We followed ~ 5,5 million individuals aged > 18 years during the period 2012–2023 for antidepressant prescriptions (reflecting primary care) or hospital-recorded depression diagnoses (reflecting secondary care). Hazard ratios (HR) of (1) antidepressants and hospital diagnoses across municipalities and (2) antidepressants and hospital diagnoses across four municipality-level socioeconomic indicators, were calculated. Lee’s L statistics were applied to assess spatial associations and median hazard ratios were estimated as a measure of between-municipality variation.

Results

We found an overall positive spatial association between the two outcomes. Most municipality-level indicators were associated with higher antidepressant prescription rates, after adjustment for individual factors, strongest for high proportions of short education and transfer payments (HR 1.16 (95% CI 1.10-1.23 and 1.17 (95% CI 1.10-1.23), respectively). Associations with hospital-recorded depression were largely attenuated, after adjustment for individual factors. Between-municipality variation was modest (MHR 1.14 for antidepressant prescriptions and 1.19 for depressions diagnoses).

Conclusion

We showed that municipalities with socioeconomic disadvantage had higher rates of antidepressant prescriptions. However, a large part of the between-municipality variation remains unexplained, highlighting the need to address contextual determinants beyond individual-level factors, even within a universal healthcare system.