Abstract
BackgroundFrom a public health perspective and for the appropriate allocation of resources it is important to understand the differences in health between areas. This paper examines the variations in morbidity and mortality between urban and rural areas.MethodsThis is a cohort study looking at morbidity levels of the population of Northern Ireland at the time of the 2001 census, and subsequent mortality over the following four years. Individual characteristics including demographic and socio-economic factors were as recorded on census forms. The urban-rural nature of residence was based on census areas (average population c1900) classified into eight settlement bands, ranging from cities to rural settlements with populations of less than 1000.ResultsThe study shows that neither tenure nor car availability are unbiased measures of deprivation in the urban-rural context. There is no indication that social class is biased. There was an increasing gradient of poorer health from rural to urban areas, where mortality rates were about 22% (95% Confidence Intervals 19%–25%) higher than the most rural areas. Differences in death rates between rural and city areas were evident for most of the major causes of death but were greatest for respiratory disease and lung cancer. Conversely, death rates in the most rural areas were higher in children and adults aged less than 20.ConclusionUrban areas appear less healthy than the more rural areas and the association with respiratory disease and lung cancer suggests that pollution may be a factor. Rural areas however, have higher death rates amongst younger people, something which requires further research. There is also a need for additional indicators of deprivation that have equal meaning in urban and rural areas.
Highlights
From a public health perspective and for the appropriate allocation of resources it is important to understand the differences in health between areas
Urban areas are associated with high levels of physical and social factors that are potentially detrimental to maintaining good health such as air pollution [1], stress [2] and fear of crime [3]
The data used in this project has been derived from a record linkage exercise undertaken by the Northern Ireland Statistics and Research Agency (NISRA) in which the enumerated 2001 Census population was linked with subsequent deaths registered over the following four years
Summary
From a public health perspective and for the appropriate allocation of resources it is important to understand the differences in health between areas. One of the most important tasks that government can do to reduce health inequalities is to ensure that the appropriate amount and type of resources are directed to those most in need. Whilst this is normally interpreted in the form of deprivation the principle of fair apportionment is as applicable to urban and rural areas, which are arguably more identifiable for targeting purposes. Access to services, including health services, is notably worse in rural areas [3]
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