TY - JOUR
T1 - Regional variation in cardiovascular mortality in Australia 2009–2012
T2 - the impact of remoteness and socioeconomic status
AU - Jacobs, Jane
AU - Peterson, Karen Louise
AU - Allender, Steven
AU - Alston, Laura Veronica
AU - Nichols, Melanie
N1 - Funding Information:
JJ, MN, KLP and LA are supported by funding from the National Heart Foundation of Australia and Deakin University. SA is supported by funding from an Australian National Health and Medical Research Council/ National Heart Foundation of Australia Career Development Fellowship (APP1045836). He is also a researcher on the US National Institutes of Health grant titled, ‘Systems Science to Guide Whole-of-Community Childhood Obesity Interventions’ (1R01HL115485-01A1) and within a NHMRC Centre for Research Excellence in Obesity Policy and Food Systems (APP1041020).
Publisher Copyright:
© 2018 The Authors
PY - 2018/10
Y1 - 2018/10
N2 - Objective: To assess the extent to which socioeconomic status (SES) contributes to geographic disparity in cardiovascular disease (CVD) mortality. Methods: An ecological study assessed the association between remoteness and CVD mortality rates, and the mediating effect of SES on this relationship, using Australia-wide data from 2009 to 2012. Results: Socioeconomic status explained approximately one-quarter of the increased CVD mortality rates for females in inner and outer regional areas, and more than half of the increased CVD mortality rates in inner regional and remote/very remote areas for males, compared to major cities. After allowing for the mediating effect of SES, females living in inner regional areas and males living in remote/very remote areas had the greatest CVD mortality rates (Mortality Rate Ratio: 1.12, 95%CI 1.07–1.17; MRR: 1.15, 95%CI 1.05–1.25, respectively) compared to those in major cities. Conclusion: Socioeconomic status explained a substantial proportion of the association between where a person resides and CVD mortality rates; however, remoteness has an effect above and beyond SES for a number of subpopulations. Implications for public health: This study highlights the need to focus on both socioeconomic disadvantage and accessibility to reduce CVD mortality in regional and remote Australia.
AB - Objective: To assess the extent to which socioeconomic status (SES) contributes to geographic disparity in cardiovascular disease (CVD) mortality. Methods: An ecological study assessed the association between remoteness and CVD mortality rates, and the mediating effect of SES on this relationship, using Australia-wide data from 2009 to 2012. Results: Socioeconomic status explained approximately one-quarter of the increased CVD mortality rates for females in inner and outer regional areas, and more than half of the increased CVD mortality rates in inner regional and remote/very remote areas for males, compared to major cities. After allowing for the mediating effect of SES, females living in inner regional areas and males living in remote/very remote areas had the greatest CVD mortality rates (Mortality Rate Ratio: 1.12, 95%CI 1.07–1.17; MRR: 1.15, 95%CI 1.05–1.25, respectively) compared to those in major cities. Conclusion: Socioeconomic status explained a substantial proportion of the association between where a person resides and CVD mortality rates; however, remoteness has an effect above and beyond SES for a number of subpopulations. Implications for public health: This study highlights the need to focus on both socioeconomic disadvantage and accessibility to reduce CVD mortality in regional and remote Australia.
KW - cardiovascular disease
KW - epidemiology
KW - health inequalities
KW - rural health
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85050567231&partnerID=8YFLogxK
U2 - 10.1111/1753-6405.12807
DO - 10.1111/1753-6405.12807
M3 - Article
C2 - 30035826
AN - SCOPUS:85050567231
SN - 1326-0200
VL - 42
SP - 467
EP - 473
JO - Australian and New Zealand Journal of Public Health
JF - Australian and New Zealand Journal of Public Health
IS - 5
ER -