Comparison of urban and rural mortality rates across the lifespan in Aotearoa/New Zealand: a population-level study.
geography
life course epidemiology
mortality
Journal
Journal of epidemiology and community health
ISSN: 1470-2738
Titre abrégé: J Epidemiol Community Health
Pays: England
ID NLM: 7909766
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
17
01
2023
accepted:
23
05
2023
medline:
14
8
2023
pubmed:
10
6
2023
entrez:
9
6
2023
Statut:
ppublish
Résumé
Previous studies undertaken in New Zealand using generic rurality classifications have concluded that life expectancy and age-standardised mortality rates are similar for urban and rural populations. Administrative mortality (2014-2018) and census data (2013 and 2018) were used to estimate age-stratified sex-adjusted mortality rate ratios (aMRRs) for a range of mortality outcomes across the rural-urban spectrum (using major urban centres as the reference) for the total population and separately for Māori and non-Māori. Rural was defined according to the recently developed Geographic Classification for Health. Mortality rates were higher overall in rural areas. This was most pronounced in the youngest age group (<30 years) in the most remote communities (eg, all-cause, amenable and injury-related aMRRs (95% CIs) were 2.1 (1.7 to 2.6), 2.5 (1.9 to 3.2) and 3.0 (2.3 to 3.9) respectively. The rural:urban differences attenuated markedly with increasing age; for some outcomes in those aged 75 years or more, estimated aMRRs were <1.0. Similar patterns were observed for Māori and non-Māori. This is the first time that a consistent pattern of higher mortality rates for rural populations has been observed in New Zealand. A purpose-built urban-rural classification and age stratification were important factors in unmasking these disparities.
Sections du résumé
BACKGROUND
Previous studies undertaken in New Zealand using generic rurality classifications have concluded that life expectancy and age-standardised mortality rates are similar for urban and rural populations.
METHODS
Administrative mortality (2014-2018) and census data (2013 and 2018) were used to estimate age-stratified sex-adjusted mortality rate ratios (aMRRs) for a range of mortality outcomes across the rural-urban spectrum (using major urban centres as the reference) for the total population and separately for Māori and non-Māori. Rural was defined according to the recently developed Geographic Classification for Health.
RESULTS
Mortality rates were higher overall in rural areas. This was most pronounced in the youngest age group (<30 years) in the most remote communities (eg, all-cause, amenable and injury-related aMRRs (95% CIs) were 2.1 (1.7 to 2.6), 2.5 (1.9 to 3.2) and 3.0 (2.3 to 3.9) respectively. The rural:urban differences attenuated markedly with increasing age; for some outcomes in those aged 75 years or more, estimated aMRRs were <1.0. Similar patterns were observed for Māori and non-Māori.
CONCLUSION
This is the first time that a consistent pattern of higher mortality rates for rural populations has been observed in New Zealand. A purpose-built urban-rural classification and age stratification were important factors in unmasking these disparities.
Identifiants
pubmed: 37295927
pii: jech-2023-220337
doi: 10.1136/jech-2023-220337
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
571-577Informations de copyright
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.