Diabetes–Depression Syndemic and Structural Deprivation: Municipal Spatial Clustering in Norte de Santander, Colombia

Abstract

The co-occurrence of diabetes mellitus and depression constitutes a growing public health challenge in Latin American regions, characterized by structural deprivation. This study examines the spatial distribution and territorial interaction of diabetes recorded prevalence, depression recorded prevalence, and multidimensional poverty across the 40 municipalities of Norte de Santander, Colombia (2023), within the theoretical framework of syndemics and structural violence. Using a spatial ecological design, four complementary methods were applied: choropleth mapping, global and local spatial autocorrelation (Moran’s I and LISA), bivariate spatial co-location analysis, and simultaneous autoregressive spatial regression (SAC). Results revealed statistically significant positive spatial autocorrelation for depression (I = 0.228, p = 0.011) and diabetes (I = 0.160, p = 0.026), with geographically distinct clustering foci: the Cúcuta metropolitan area concentrated diabetes hotspots, while the Ocaña subregion and the Ábrego–Hacarí axis concentrated depression and poverty hotspots. Because disease measures are derived from administrative records, higher urban prevalence may partly reflect greater case ascertainment. SAC models show that municipal recorded prevalence of depression and diabetes are positively and reciprocally associated under alternative specifications; a spatial co-patterning consistent with, but not a direct test of, a syndemic interaction. These geographically differentiated syndemic foci require territory-specific integrated care policies targeting metabolic and mental health simultaneously, particularly in the high-vulnerability municipalities of the Ocaña area in the Catatumbo region.