New research conducted by the University of Otago has shown that people living in rural areas of Aotearoa have higher mortality rates compared to those residing in major urban centres.
The findings, which contradict previous data, provide strong evidence that rural New Zealanders experience poorer health outcomes. The study, published in the Journal of Epidemiology and Community Health, is the first to establish a consistent pattern of higher mortality rates among rural populations.
Analyzing mortality data from the Ministry of Health and Statistics New Zealand, researchers examined 160,179 registered deaths in New Zealand between 2014 and 2018. The study categorized deaths into five outcomes: all-cause, amenable (potentially avoidable with timely and effective healthcare), cardiovascular, cancer, and injury-related deaths.
The results indicated higher mortality rates in rural areas across all age groups under 60.
The most significant disparities were observed among those under 30 years old in the most rural communities where the mortality rates were double that of the most urban centres - 599 deaths in urban areas per 100,000 compared with 1,085 in rural areas.
The study also highlighted the pronounced impact on the Māori population. Both rural Māori and rural non-Māori had higher mortality rates compared to their urban counterparts. However, the consequences for Māori were greater, as rural living compounded their already high mortality rates.
The age-standardized mortality rate for Māori living in the most rural areas was 4,018 per 100,000, while for non-Māori, it was 3,055 per 100,000. Additionally, Māori were more likely to reside in rural and remote areas, and their younger age groups experienced the greatest impact on mortality rates due to rurality.
Interestingly, the study revealed a reversal of disparities among individuals aged over 75.
Older rural non-Māori exhibited slightly lower mortality rates, while older rural Māori had mortality rates similar to their urban peers. However, it is important to note that this finding does not necessarily indicate a healthier older rural population.
The migration of elderly and frail rural individuals to access residential care and health services might explain this trend.
The study did not analyze the specific reasons for these disparities, but the researchers suggest they are likely to be multifaceted and complex. While healthcare is undoubtedly a contributing factor, socioeconomic factors may also play a significant role. Further investigation is required to understand the extent to which these disparities can be attributed to different factors.
The research findings challenge the assumption that rural health outcomes in New Zealand are as good as, if not better than, those in urban areas. Higher mortality rates in rural areas, particularly in the amenable category (indicative of healthcare coverage and quality), have important implications for the delivery of equitable healthcare to rural populations.
