A comparison of the modelled impacts on CVD mortality if attainment of public health recommendations was achieved in metropolitan and rural Australia

Abstract

Objective:To (i) determine the proportion of deaths from CVD that could be avoided in both rural and metropolitan Australia if public health recommendations were met; (ii) assess the impact on the rural CVD mortality; and (iii) determine if policy priorities should be different by rurality for CVD prevention.Design:A macro-simulation modelling study of population data. Population, risk factor and CVD death data stratified by rurality were analysed using the Preventable Risk Integrated Model. The baseline scenario was the current risk factor levels (including physical activity, smoking, diet and alcohol). The counterfactual scenario was the population levels of these risk factors expected if public health recommendations were met.Setting:Metropolitan and rural Australia.Participants:Rural- and metropolitan-dwelling adults in Australia.Results:Both populations would experience similar relative declines in the proportion of deaths from CVD. A total of 14 892 deaths from CVD would be avoided annually; with similar declines in the proportions of deaths by rurality. Critically, the order of policy priorities for public health recommendation attainment would differ by rurality CVD prevention, with addressing fat intakes being a higher priority in rural areas.Conclusions:Achieving public health recommendations in Australia would result in large declines in CVD mortality. Despite declines in overall CVD mortality under this scenario, an inequality in CVD burden would persist for rural populations. The order of risk factor priorities would differ by rurality.

Limited dietary interventions in rural Australian communities: A systematic review

“…Dietary risks and obesity contributed to almost half of the burden of disease attributed to exposure to risk factors 3 . People who live in rural and remote areas of Australia experience more significant impact from diet‐related chronic diseases, with higher rates of overweight and obesity, cardiovascular disease, type 2 diabetes, high blood pressure, and chronic kidney disease, than their metropolitan counterparts 2,4 . An Australian Institute of Health and Welfare report in 2019 showed that only 1 in 10 people living outside major cities reported meeting requirements for vegetable intake, and fewer Australians living in rural areas meet fruit recommendations than their metropolitan counterparts, 2 presenting an opportunity target for policy and interventions seeking to decrease preventable disease burden in rural areas.…”

“…Diet plays a role in rural health inequalities, such as disparities in cardiovascular disease 4,5 . A recent study suggests that the gap in ischaemic heart disease mortality between rural and metropolitan Australia could be reduced by almost half if rural Australians were able to meet recommendations for diet, reduce alcohol, meet activity guidelines, and cease smoking tobacco 4 .…”

“…Diet plays a role in rural health inequalities, such as disparities in cardiovascular disease 4,5 . A recent study suggests that the gap in ischaemic heart disease mortality between rural and metropolitan Australia could be reduced by almost half if rural Australians were able to meet recommendations for diet, reduce alcohol, meet activity guidelines, and cease smoking tobacco 4 . However, people living in rural and remote regions of Australia have less access to allied health services, such as dietitians, to support prevention and self‐management of chronic diseases 6 .…”

“…Moreover, when private dietetic services are available, people living in rural Australia may not be able to afford private practice fees 7 . There is Australian recognition that cost‐effective interventions and policies are urgently needed to reduce health inequalities and to improve the dietary intakes of at‐risk rural populations 4 …”

Understanding the healthfulness of outlets providing lunch and dinner meals: a census of a rural food retail environment in Victoria, Australia

“…According to the 2017–18 National Health Survey, rural‐dwelling Australians were more likely to consume sugar‐sweetened drinks daily (14%) than their counterparts in major cities (8%), while less than 10% of rural people met guidelines for vegetable intake 3 . Modelling studies indicate that Australians meeting dietary guidelines would reduce cardiovascular disease mortality by as much as 50% in rural areas, and reduce inequities in rates between rural and metropolitan areas 4 …”