Sue Crengle, Gabrielle Davie, Jesse Whitehead, Brandon de Graaf, Ross Lawrenson & Garry Nixon

OPEN ACCESS: Lancet Regional Health – Western Pacific 2022;28:100570. Published August 18, 2022 DOI: https://doi.org/10.1016/j.lanwpc.2022.100570

This paper is the first to use the new Geographic Classification of Health (https://blogs.otago.ac.nz/rural-urbannz/) to examine rural:urban differences and demonstrates how the GCH will impact health policy and research going forward.  Crengle et al. confirm that Māori living rurally face greater mortality incidence rates than non-Māori or urban-based Māori whereas previous studies, using older classifications, found rural Māori mortality was comparable to that of Māori living in metropolitan areas.

Summary

Background

Previous research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas. 

Methods

A population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality, and census data. For each level of the Geographic Classification for Health (GCH), Māori and non-Māori age-sex standardised all-cause mortality and amenable mortality incident rates, Māori:Non-Māori standardised incident rate ratios, and Māori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated. 

Findings 

Compared to non-Māori, Māori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Māori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Māori and non-Māori all-cause and amenable mortality rates increased as rurality increased. 

Interpretation

The excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.