Socioeconomic and regional disparities in the diagnosis of primary arrhythmias in a universal healthcare system: A nation-wide danish study

Background

Inherited primary arrhythmia syndromes carry a significant risk of sudden cardiac death (SCD). However, diagnosis and management vary widely even within global healthcare systems. This study examines nationwide geographic, socioeconomic, and regional disparities in Denmark.

Methods

We performed a nationwide cross-sectional registry-based study among patients with primary arrhythmias analysing prevalence rates, socioeconomic factors, proximity to specialized clinics, and treatment patterns compared to the general population.

Findings: We identified 1.541 patients with a primary arrhythmia syndrome (female sex 57%, median age 51) of which the majority had long QT-syndrome (78% LQTS, 19% BrS, 3% CPVT). The prevalence rate of any primary arrythmia syndrome was 25.9 per 100,000 individuals (95% CI: 24.6-27.3) with marked regional differences in prevalence rate. Compared to age and sex-matched controls from the general population, cases had a higher burden of both cardiovascular and non-cardiovascular comorbidities. Notably, anxiety was significantly more prevalent among cases (13% vs 4.5%, p<0.001). Further, significant disparities in socioeconomic status were identifies with lower levels of education (p<0.001), median household income (p=0.002) and employment status (p<0.001) among cases with primary arrythmias. Driving distance to nearest specialized inherited cardiac disease clinic was significantly closer among cases (22 vs 25 km, p<0,001). Regional disparities in treatment patterns with both betablockers and ICD implantation was observed.

Interpretation: Despite equal and universal healthcare in Denmark geographic, socioeconomic, and systemic factors contribute to disparities in the diagnosis and management of inherited arrhythmias. Targeted public health strategies, improved referral pathways, and enhanced clinical education are needed to ensure equitable access to diagnosis and care, ultimately reducing SCD risk