You are here

Article Text

Article menu
Download PDFPDF
Original research
Comparison of urban and rural mortality rates across the lifespan in Aotearoa/New Zealand: a population-level study
  1. Garry Nixon1,
  2. Gabrielle Davie2,
  3. Jesse Whitehead3,
  4. Rory Miller1,
  5. Brandon de Graaf2,
  6. Ross Lawrenson4,
  7. Michelle Smith1,
  8. John Wakerman5,
  9. John Humphreys6,
  10. Sue Crengle7
  1. 1 General Practice and Rural Health, University of Otago, Dunedin, New Zealand
  2. 2 Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  3. 3 Te Ngira: Institute for Population Research, University of Waikato, Hamilton, New Zealand
  4. 4 Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
  5. 5 Alice Springs Office, Menzies School of Health Research, Alice Springs, Northern Territory, Australia
  6. 6 School of Rural Health, Monash University, Bendigo, Victoria, Australia
  7. 7 Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
  1. Correspondence to Professor Garry Nixon, Department of General Practice and Rural Health, University of Otago, Dunedin, Otago, New Zealand; garry.nixon{at}otago.ac.nz

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.

  • mortality
  • life course epidemiology
  • geography

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/jech-2023-220337

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available on reasonable request.

    View Full Text

    Footnotes

    • Twitter @whitehead_nz

    • Contributors GN’s contribution included conception of the study design, leading the writing of the first draft and revision of the paper, and is the author responsible for the overall content as guarantor . GD acquired the data and undertook the statistical analysis as well as writing sections of the initial and revised manuscript. JWi helped design the study and the underlying geographic classification. He contributed to the writing of the initial and revised manuscripts. RM contributed to the conception of the study, helped with the analysis and reviewed drafts of the manuscript. BdG prepared the data, undertook the initial analysis and prepared the figures. RL contributed to the study design, advised on the analysis and reviewed versions of the manuscript. MS helped organise the study and the research team and reviewed the manuscript. JWa contributed to the conception of the study design, reviewed drafts of the paper and provided the international commentary. JH contributed to the conception of the study design, advised on the geographic analysis and reviewed early drafts of the paper. SC helped with the conception of the study, led the ethnic-specific analyses and contributed to the writing of the initial and revised manuscripts.

    • Funding This project was funded by a grant from the Health Research Council of New Zealand (HRC19/488).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.