Developing a New Index of Rurality for Exploring Variations in Health Outcomes in Auckland and Northland

Abstract

Health inequalities between urban and rural areas are prevalent in many countries. However, rurality is a multifaceted concept so it is important to specify which aspects of rurality are most relevant to the analysis of urban/rural health disparities. Drawing from international research, we identified four domains that are most relevant to measuring rurality: (1) access to service facilities; (2) percentage of natural space; (3) population density; and (4) percentage of people employed in farming-related occupations. For the Auckland and Northland regions of New Zealand, we calculated a score for each of the four domains and combined them into a multi-dimensional index of relative rurality for health research using network analysis and various statistical approaches. We further developed an urban/rural typology that characterises urban and rural areas using quantitative criteria including thresholds and different combinations of domains and indicators of rurality. The rurality index, the typology and existing classifications were assessed in relation to all-cause mortality. The findings of this preliminary study provide useful insights into the potential benefits of a conceptually rigorous, granular and multi-dimensional index which incorporates characteristics that can differentiate levels of rurality in New Zealand more than existing classifications. Validation studies and assessment of associations with specific health outcomes would be useful next steps in considering the utility of this rurality index for New Zealand more generally.