Negative associations between neighbourhood socioeconomic disadvantage and health are well documented. However, limited longitudinal evidence exists on the dynamic nature of the neighbourhood context and implications for health disparities. Using rich register data, we examined how neighbourhood disadvantage in Denmark changed over three decades and explored associations with mortality rates.
This ecological study used nationwide register data from 1987 to 2018. A neighbourhood socioeconomic disadvantage index was created using aggregated data on neighbourhood-level educational attainment, unemployment and family income. Trends in the neighbourhood index were assessed using descriptive and geospatial analyses. Associations with age-standardised mortality rates were plotted and examined in regression-based models.
Neighbourhood socioeconomic conditions generally improved over the three decades, and the mean difference between disadvantaged quartiles narrowed. The location of the most and least disadvantaged quartiles was largely stable across the period. Mortality rates generally decreased over time; however, rates of decline differed, leading to increased mortality disparities by quartile of neighbourhood disadvantage. Regression analysis demonstrated an increase in the association between neighbourhood disadvantage and mortality rates over time. First-difference regression models showed no association between change in neighbourhood disadvantage and change in mortality rates.
Despite general improvements in neighbourhood socioeconomic conditions and neighbourhood mortality rates across the last three decades in Denmark, we found growing health inequality between more and less disadvantaged neighbourhoods. A strong concentration of disadvantage over time and space and growing segregation of income levels may have contributed to this development, with important implications for public policy and health policy investments.