Abstract
BackgroundIt remains unclear why living outside of an urban environment affects aspects of health, particularly whether these differences can be explained by other factors such as socioeconomic position (SEP). The aim of this study was to compare health risk factors between metropolitan and non-metropolitan young Australian adults and examine whether socioeconomic position (SEP) mediates any differences.MethodsCross-sectional data came from an Australia-wide sample of 26–36 year-olds (n = 2567). Information on demographic characteristics, smoking, alcohol consumption, diet, physical activity (PA, mins/week) and mental health were collected by questionnaire, BMI from measured height and weight and daily steps using pedometers. Metropolitan versus non-metropolitan residence was classified from addresses. SEP included individual-level (education, occupation) and area-level measures. Prevalence ratios and ratio of means were calculated using log binomial, log multinomial and linear regression techniques.ResultsNon-metropolitan residents were less likely to meet 2 or more dietary guidelines, reported less leisure-time PA and active commuting but more occupational and domestic PA than metropolitan residents. Non-metropolitan women were more likely to smoke and be obese. No differences in mental health were found. After adjusting for SEP, differences remained significant except for leisure-time PA (men and women) and smoking (women).ConclusionsLiving outside metropolitan areas was associated with more risk factors in these young adults. Individual SEP and area-level disadvantage generally did not explain these differences, suggesting that a focus on geographic location as its own social determinant of health, beyond SEP, is warranted.
Highlights
It remains unclear why living outside of an urban environment affects aspects of health, whether these differences can be explained by other factors such as socioeconomic position (SEP)
Recent national data from the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS) shows that people living in non-metropolitan areas were more likely to be daily smokers, overweight or obese, be insufficiently active and drink alcohol at levels that place them at risk of harm over their lifetime compared to those living in metropolitan areas [19]
Differences in health risk factors by area of residence Men Differences in risk factors were found between metropolitan and non-metropolitan men for physical activity and diet, but not for smoking, alcohol consumption, Body mass index (BMI), or anxiety and depression (Table 2)
Summary
It remains unclear why living outside of an urban environment affects aspects of health, whether these differences can be explained by other factors such as socioeconomic position (SEP). The aim of this study was to compare health risk factors between metropolitan and non-metropolitan young Australian adults and examine whether socioeconomic position (SEP) mediates any differences. The few peerreviewed Australian studies investigating urban–rural differences in health risk factors have focussed on women [16,17] and on physical activity [18], with little information available for men. Recent national data from the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS) shows that people living in non-metropolitan areas were more likely to be daily smokers, overweight or obese, be insufficiently active and drink alcohol at levels that place them at risk of harm over their lifetime compared to those living in metropolitan areas [19]. Government policies in Australia and elsewhere have a focus on improving health for those living outside metropolitan areas; these are based largely on descriptive analyses without adjustment for important potential confounders, so it is unclear what aspects of non-metropolitan areas should be targeted
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