School of Population Health, The University of Queensland, Herston.
Aust N Z J Public Health. 2010 Dec;34(6):624-8. doi: 10.1111/j.1753-6405.2010.00623.x. Epub 2010 Nov 25.
Death rates in Australia are higher in rural than urban areas. Our objective is to examine causes of death of urban and rural women to gain insight into potential explanations for differences in mortality.
Participants were a community-based random sample of women (n=12,400) aged 70-75 years when recruited in 1996 to the Australian Longitudinal Study on Women's Health. The main variables used were: area of residence classified according to the Australian Standard Geographic Classification (ASGC), survival to 31 October 2006, cause of death, selected risk factors.
The total number of deaths at 31 October 2006 was 2,803 and total number of women still alive was 9,597. Mortality was higher for women in rural areas overall (hazard ratio (HR)=1.09; 95% confidence interval (CI): 1.01-1.18) and for most major causes of death compared to urban women. In particular, death rates were substantially higher for lung cancer (HR=1.52; 95% CI: 1.03-2.25) and chronic obstructive pulmonary disease (COPD) (HR=1.83; 95% CI: 1.25-2.69). Nevertheless there were almost no differences among the groups for current smoking or smoking history. Prevalence of overweight and obesity was slightly higher and levels of physical activity lower among women in remote areas.
There is little evidence that differences in mortality are due to the risk factors considered. Alternative explanations such as inequities in health services and environmental hazards should be considered.
People in rural areas may suffer from a double disadvantage of poorer health services and exposure to health hazards that are less common in urban areas.
澳大利亚的农村地区死亡率高于城市地区。我们的目的是研究城市和农村女性的死因，以深入了解导致死亡率差异的潜在原因。
参与者是 1996 年招募的年龄在 70-75 岁的参与社区的女性随机样本（n=12400）。主要使用的变量是：根据澳大利亚标准地理分类（ASGC）分类的居住区域、截至 2006 年 10 月 31 日的生存情况、死因、选定的危险因素。
截至 2006 年 10 月 31 日，总死亡人数为 2803 人，仍存活的妇女总数为 9597 人。农村地区女性的死亡率总体较高（风险比（HR）=1.09；95%置信区间（CI）：1.01-1.18），与城市女性相比，大多数主要死因的死亡率都较高。特别是，肺癌（HR=1.52；95% CI：1.03-2.25）和慢性阻塞性肺疾病（COPD）（HR=1.83；95% CI：1.25-2.69）的死亡率高得多。然而，在当前吸烟或吸烟史方面，各组之间几乎没有差异。偏远地区女性超重和肥胖的比例略高，身体活动水平略低。
几乎没有证据表明死亡率的差异是由于考虑到的危险因素造成的。应考虑其他解释，如卫生服务不平等和环境危害。
农村地区的人可能会遭受卫生服务较差和接触较少见的城市地区健康危害的双重劣势。
