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Inequalities in Health Outcomes in Rural Areas - RE0230

Description
1. Summary statement
This is a consortium bid from the Office for National Statistics, Cardiff University and the Wales Centre for Health. Previously, this group has published work on differences in mortality between rural and urban areas in England and Wales. This research raised many interesting questions which are of major public health importance, which relate directly to the detailed requirements laid out in the competition details and project specification for the ‘Inequalities in health outcomes in rural areas’ project. Analyses based on mortality and Census 2001 data are proposed to answer the following clusters of questions:
1. Do the differences that exist between rural and urban areas mask much larger differences in mortality between more specific types of rural and urban areas?
2. Is there an association between the number of deaths from three causes linked to poor access to emergency medical services (death from head injury, AMI, and involvement in a transport accident), and distance from where a death occurred to the nearest accident and emergency unit, and if so, are the distances between place of death and the nearest A&E department higher in specific RUAC categories for each cause?
3. Do people's perceptions of their own health differ with degree of rurality, is there evidence that people are more likely to have moved out of rural areas if they report their health to be poor, and what is the influence of socio-economic status?
4. Does deprivation in a rural area have a greater, lesser or similar effect on life expectancy than deprivation in an urban area?
It is anticipated that the results from these analyses would provide evidence of the needs of people in rural communities, which could then be addressed through public policy and delivery.
Objective
The consortium of researchers from ONS, Cardiff University and the Wales Centre for Health (WCfH) who are submitting this proposal recently published an article on differences in mortality between rural and urban areas in England and Wales, 2002-04 (Gartner et al., 2008). This was the culmination of a 6-month collaboration between the consortium members from these three organisations, in which we extensively reviewed the literature on differences in rural and urban mortality, analysed a range of methods of measuring area deprivation to investigate which were most valid for measuring rural and urban differences, and compared rural and urban mortality adjusting for area level deprivation. Results were presented for all-cause mortality, and specific causes (circulatory diseases, all cancers, lung cancer, respiratory diseases, accidents and suicides), by the six Rural and Urban Area Classification (RUAC) categories, as well as the urban/rural dichotomy.

The unadjusted results from this study appeared to support the idea of a health advantage associated with rural residency. However, we repeated the analysis to take account of area deprivation using the Townsend index of deprivation, the Index of Multiple Deprivation (IMD) 2004 (overall index and specific domains) for England, and the Welsh Index of Multiple Deprivation (WIMD) for Wales (overall index and specific domains). These adjusted results revealed that much of the health advantage associated with rural areas is explained by differences in area deprivation, with adjusted odds ratios close to 1. There were some notable exceptions; lung cancer and respiratory disease mortality rates remained high in urban areas, and accident mortality rates were found to be relatively high for rural areas. Interestingly, the different measures of deprivation (including the analyses using specific domains of the IMD 2004 and WIMD) gave similar results.

This research raised many interesting questions which are of major public health importance, which relate directly to the detailed requirements laid out in the competition details and project specification for the ‘inequalities in health outcomes in rural areas’ project. For example, do specific aspects of deprivation (such as the ‘income’ and ‘employment’ domains as defined in the IMD 2007) have the greatest impact on mortality by specific causes, and within each broad cause (eg: circulatory diseases), and do more deaths occur from specific causes such as acute myocardial infarction (AMI) in particular rural categories, possibly because of poor access to medical services? The previous work carried out by this consortium on rural health, deprivation and mortality would allow this team to investigate these specific questions, and others as detailed in Section 4 below without delay, if this bid were successful.
Project Documents
• FRP - Final Report : Inequalities in Health Outcomes in Rural Areas - Final report   (1033k)
Time-Scale and Cost
From: 2008

To: 2009

Cost: £72,474
Contractor / Funded Organisations
Office for National Statistics
Keywords
Health              
Rural Communities              
Rural Development              
Rural Issues              
Fields of Study
Rural Affairs