A comparison of Australian rural and metropolitan cardiovascular risk and mortality: the Greater Green Triangle and North West Adelaide population surveys

Abstract

ObjectivesCardiovascular (CVD) mortality disparities between rural/regional and urban-dwelling residents of Australia are persistent. Unavailability of biomedical CVD risk factor data has, until now, limited efforts to understand the causes of the disparity. This study aimed to further investigate such disparities.DesignComparison of (1) CVD risk measures between a regional (Greater Green Triangle Risk Factor Study (GGT RFS, cross-sectional study, 2004–2006) and an urban population (North West Adelaide Health Study (NWAHS, longitudinal cohort study, 2004–2006); (2) Australian Bureau of Statistics (ABS) CVD mortality rates between these and other Australian regions; and (3) ABS CVD mortality rates by an area-level indicator of socioeconomic status, the Index of Relative Socioeconomic Disadvantage (IRSD).SettingGreater Green Triangle (GGT, Limestone Coast, Wimmera and Corangamite Shires) of South-Western Victoria and North-West Adelaide (NWA).Participants1563 GGT RFS and 3036 NWAHS stage 2 participants (aged 25–74) provided some information (self-administered questionnaire +/− anthropometric and biomedical measurements).Primary and secondary outcome measuresAge-group specific measures of absolute CVD risk, ABS CVD mortality rates by study group and Australian Standard Geographical Classification (ASGC) region.ResultsFew significant differences in CVD risk between the study regions, with absolute CVD risk ranging from approximately 5% to 30% in the 35–39 and 70–74 age groups, respectively. Similar mean 2003–2007 (crude) mortality rates in GGT (98, 95% CI 87 to 111), NWA (103, 95% CI 96 to 110) and regional Australia (92, 95% CI 91 to 94). NWA mortality rates exceeded that of other city areas (70, 95% CI 69 to 71). Lower measures of socioeconomic status were associated with worse CVD outcomes regardless of geographic location.ConclusionsMetropolitan areas do not always have better CVD risk factor profiles and outcomes than rural/regional areas. Needs assessments are required for different settings to elucidate relative contributions of the multiple determinants of risk and appropriate cardiac healthcare strategies to improve outcomes.

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

“…The same rural–metropolitan differential in Western Australia was reported for the incidence of MI in Western Australia 32. However, conflicting evidence was reported from a CVD risk study on South-West Victoria and North-West Adelaide, Australia 30. That study examined cardiovascular mortality rates without comprehensive adjustment and only a small proportion of the patients examined were Aboriginal 30.…”

“…Moreover, there may be limited access to comprehensive primary healthcare services, poor integration between different levels of care and inadequate services to support ongoing home-based intervention and HF self-management,25 HF-specific cardiac rehabilitation programmes26 and socioculturally appropriate services 27–29. Hence, the dimension of metro–rural divide in the context of Western Australia is larger than that which occurs in other states 30. Issues of rural and remote health are much more complex than merely the practice of health in another location3 and are affected by issues such as workforce shortages and retention of healthcare workers, higher out-of-pocket costs and the time and cost of travel 3…”

“…This is evident from the differences in profiles of care between the two subpopulations and the findings that showed rural patients were utilising EDs to fill the gaps in the primary healthcare and the specialist services in rural areas. Other evidence shows that increasing private health insurance coverage in Australia has been associated with loss of equity after controlling for other factors 30 31…”

Diabetes and poor glycaemic control in rural patients with coronary artery disease

“…This is particularly true for subjects from Outer Regional Victoria, of whom two-thirds of those without a history of diabetes had unrecognised hyperglycaemia. The relevance of this finding extends beyond cardiovascular health; diabetic patients have a high burden of disease, and can go on to develop peripheral vascular disease, cerebrovascular disease, retinopathy, neuropathy, and renal disease, to name but a few complications [4,[16][17][18].…”

“…Awareness of regional health has been a focus of Australian health policy for many years, and the existing literature on this topic is based on comprehensive risk factor surveys of regional and national health [11,14,15]. Local studies on CVRFs have recruited from electoral rolls or used Census data, where rurality has not necessarily correlated with cardiovascular mortality or morbidity [16,17], or the findings have been gender specific [18]. However, the usefulness of this data is limited by the lack of blood tests in determining the presence of a risk factor, relying instead on patient recall and potentially reflecting patient awareness rather than true prevalence.…”