Nixon, Garry, Gabrielle Davie, Jesse Whitehead, Rory Miller, Brandon de Graaf, Ross Lawrenson, Michelle Smith, John Wakerman, John Humphreys, and Sue Crengle. “Comparison of urban and rural mortality rates across the lifespan in Aotearoa/New Zealand: a population-level study.” J Epidemiol Community Health (2023).

 

Using mortality data from the Ministry of Health and Statistics New Zealand, the awesome GCH team, led by our very own Prof Garry Nixon analysed the age, sex, ethnicity and cause of 160,179 deaths registered in New Zealand between 2014 and 2018.  Deaths were categorised into five outcomes; all-cause, amenable (those that are potentially avoidable if given effective and timely healthcare), cardiovascular, cancer and injury. The results – which contradict existing data – are the strongest evidence yet that all New Zealanders who live in rural areas have poorer health outcomes across all groups aged under 60. The largest disparities were most apparent among those aged under 30 in the most rural communities where the mortality rates were double that of the most urban centres.

The disparities are most evident for injury and amenable death.

Results have major implications for rural health policy in ensuring equitable delivery of healthcare.

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ABSTRACT

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.