Aim: To investigate the COVID-19 situation across geographical areas of Denmark over time. Methods: We used COVID-19 data from the Danish State Serum Institute on national, regional and municipality level. Cumulative number of tests, incidence, hospitalizations and deaths per 100,000 inhabitants were analysed for the five Danish regions and for all of Denmark. The cumulative number of tested and incidence of COVID-19 per 100,000 was compared for the two municipalities, Lolland and Gentofte. A sensitivity analysis of the COVID-19 indicators on a regional level was performed using number of tested as the denominator. Results: The Capital Region ranked highest on all analysed COVID-19 indicators with 10,849 tested, 365 cases, 63 hospitalized and 18 deaths per 100,000 by 2 June 2020. The three regions in western Denmark all had low levels, while Region Zealand ranked second highest. Despite general low health status in Lolland municipality, the cumulative incidence of COVID-19 was consistently below that of Gentofte. Sensitivity analysis showed that the Capital Region had the highest number of COVID-19 cases per 100,000 tested, but Region Zealand had a higher number of hospitalized and similar number of deaths per 100,000 tested as the Capital Region over time. Conclusion: COVID-19 had affected eastern Denmark, especially the Capital Region, considerably more than western Denmark. The difference may relate to population density and housing conditions.

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Background Lolland-Falster is a rural area of Denmark, where the life expectancy is presently almost six years lower than in the rich capital suburbs. To determine the origin of this disparity, we analysed changes in mortality during 50 years in Lolland-Falster. Methods Annual population number and number of deaths at municipality level were retrieved from StatBank Denmark and from Statistics Denmark publications, 1968–2017. For 1974–2017, life expectancy at birth by sex and 5-year calendar period was calculated. From 1968 to 2017, standardised mortality ratio (SMR) for all-cause mortality was calculated by sex, 5-year calendar period and municipality, with Denmark as standard and including 95% confidence intervals (CI). Results In 1968–2017, life expectancy in Lolland-Falster increased, but less so than in the rest of Denmark. Fifty years ago, Lolland-Falster had a mortality similar to the rest of Denmark. The increasing mortality disparity developed gradually starting in the late 1980s, earlier in Lolland municipality (western part) than in Guldborgsund municipality (eastern part), and earlier for men than for women. By 2013–2017, the SMR had reached 1.25 (95% CI 1.19–1.31) for men in the western part, and 1.11 (95% CI 1.08–1.16) for women in the eastern part. Increasing mortality disparity was particularly seen in people aged 20–69 years. Conclusions This study is the first to report on increasing geographical segregation in all-cause mortality in a Nordic welfare state. Development of the mortality disparity between Lolland-Falster and the rest of Denmark followed changes in agriculture, industrial company closure, a shipyard close-down, administrative centralisation, and a decreasing population size.