Geographical variation in access to specialized treatment of functional somatic disorders-a cross-sectional study

Social and geographic inequalities in access to health care are well-documented. Patients with lower socioeconomic status often receive less specialized care, and geographical distance to treatment centers can further limit access-especially for vulnerable groups. Functional somatic disorders (FSDs), affecting approximately 15% of Danish adults, are frequently associated with social disadvantage and complex health care needs. Despite national efforts to provide equal access through regional treatment centers, potential disparities in diagnosis and treatment due to geographical variation remain underexplored.

To investigate geographical variation in referral to and initiation of specialized treatment for severe FSDs and, secondarily, to describe individual and organizational characteristics that may influence access across regions.

A three-part cross-sectional study was conducted using data from five Danish administrative health registers and the national clinical database, FuncData (1 February 2019-31 December 2022). All Danish citizens aged 18-65 were included. Patients with FSD was calculated by identifying patients discharged from hospitals with a symptom diagnosis. Prevalence of FSD, referral, and treatment initiation at Centers for Functional Somatic Disorder (CFDs) were calculated at municipality level. The association between sociodemographic characteristics and access to CFDs was analyzed and reported as relative risk.

The prevalence of FSD was 6%; of those, 1% was referred to a CFD and 50% initiated treatment. Geographical variations were found across the Danish municipalities. The prevalence of FSD ranged from 3.5% to 9.8%, generally lower near CFDs. Referrals ranged from 0% to 2.5%, and treatment initiation among referred patients from 0% to 100%, both lowest in municipalities that were far from CFDs. Patients with FSD were more likely to be older, female, socioeconomically disadvantaged, and less likely to have a partner.

The study revealed geographical variations in the prevalence of FSD, referral to, and initiating specialized treatment across municipalities in Denmark. Differences were also observed for age, sex, and various socioeconomic factors, which may be part of the reason for the variation found between the municipalities.