The Rural Mortality Puzzle: New Evidence Unpacked
G. Davie, J. Whitehead, S. Crengle, J. Atkinson, P. Crampton, B. de Graaf, K. Blattner, G. Nixon. (2026) Rurality, Deprivation and Ethnicity in New Zealand: Population Distributions and Intersecting Impacts on Mortality. Australian Journal of Rural Health. 34:e70146
2026-01-29
OPEN ACCESS: https://doi.org/10.1111/ajr.70146
Findings challenge the assumption that rural–urban health disparities can be solely attributed to ethnicity and socioeconomic status, suggesting a more complex interplay of factors.
ABSTRACT
Objective
To understand how rurality and socioeconomic deprivation intersect to influence health outcomes for Māori (Indigenous population) and non-Māori in Aotearoa New Zealand (NZ).
Methods
Firstly, Census 2018 was used to describe population-level distributions of NZ's 4.7 million residents by rurality [measured using the Geographic Classification for Health (GCH)], socioeconomic deprivation [using NZ's Deprivation Index (NZDep)], and ethnicity (Māori and non-Māori). Secondly, using the national Mortality Collection as the numerator and Census-based population estimates as the denominator, rural: urban mortality rate ratios (MRRs) for Māori and non-Māori, adjusted for NZDep, were estimated from multivariate Poisson regression models.
Results
For the NZ population, rurality and socioeconomic deprivation were found to intersect differently for Māori and non-Māori. Of the 160 170 all-cause deaths in 2014–2018, 64% were 75 years or older. Almost half (46%) of the deaths in those under 75 years were considered amenable. For Māori and non-Māori aged 45–59 years, higher rates of mortality (all-cause and amenable) for rural residents, compared to urban, were attenuated when adjusted for socioeconomic deprivation. In those under 45 years, rural: urban disparities in mortality (all-cause and amenable) remained; for example, for Māori the crude amenable MRR was 1.31 (95% CI 1.17, 1.47) and the adjusted, 1.26 (95% CI 1.13, 1.41); for non-Māori, the respective estimates were 1.45 (95% CI 1.33, 1.58) and 1.46 (95% CI 1.33, 1.59).
Conclusions
Māori ethnicity, living in rural areas and socioeconomic deprivation frequently co-exist. Rural–urban disparities in all-cause and amenable mortality evident in younger age groups, particularly those under 45 years of age, cannot be explained by ethnicity or socioeconomic deprivation.