Regional and Socioeconomic Disparities in the Diagnosis of Primary Electrical Diseases in a Universal Healthcare System: A Nationwide Danish Study

BACKGROUND: Primary electrical diseases (PED) carry a significant risk of sudden cardiac death (SCD). Diagnosis, management, and access to care vary across regions even within universal healthcare systems. We examined nationwide geographic, socioeconomic, and treatment disparities in Denmark. METHODS: We conducted a nationwide registry-based study of individuals diagnosed with PED (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia) between 2007 and 2024 in Denmark. Cases were compared to sex- and age matched individuals in the background population. Outcomes included disease prevalence, proximity to specialized clinics, treatment patterns, comorbidities, and socioeconomic status. RESULTS: We identified 1,132 individuals with PED. Overall prevalence was 19.0 per 100,000, with regional variation highest in North Denmark (26.8) and lowest in Central Denmark (12.9). Prevalence was higher in capital municipalities than in other municipality types. Cases lived closer to specialized inherited cardiac clinics than matched controls (50% shorter distance in the Capital Region; 18.9% shorter in Southern Denmark). Psychiatric comorbidities, notably anxiety and affective disorders, were more frequent in cases than controls (15% vs 11%). Beta-blocker use and ICD implantation were markedly higher in cases with regional variation. Socioeconomic differences were modest, with immigrants underrepresented among diagnosed cases. CONCLUSION: Even within a universal healthcare system, geographic and systemic factors contribute to disparities in the diagnosis and management of PED. Differences in proximity to specialized clinics, regional referral practices, and treatment patterns may influence detection and care. Targeted strategies to improve awareness, referral pathways, and equitable access are needed to optimize diagnosis, management, and SCD prevention.