Abstract

BackgroundAlthough efforts have been made to articulate rural–urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. Small-area level investigations of health inequalities will likely show more detailed pictures of health inequalities among diverse rural communities, but they are difficult to conduct, particularly in a small population region. The objectives of this study were: 1) to compare life expectancy at birth for females and males across small-areas classified by locally defined settlement types for a small province in Canada; 2) to assess whether any of the settlement types explains variations in life expectancy over and above the extent of socioeconomic disadvantage and social isolation; and 3) to examine variations in life expectancies within a (larger) area unit used as the basis of health inequality investigations in previous studies.MethodsSeven settlement types were determined for the ‘community’ units based on population per-kilometre-road density and settlement forms. Mean life expectancies at birth for both genders were compared by settlement type, both for the entire province and within the Halifax Regional Municipality—the province's only census designated metropolitan area, but also contains rural settlements. Linear regression analyses were conducted to assess the statistical associations between life expectancy and the settlement types, adjusting for indicators of community-level deprivation.ResultsWhile types of communities considered as ‘rural’ generally had lower life expectancy for both genders, the effects of living in any settlement type were attenuated once adjusted for socioeconomic deprivation and social isolation. An exception was the village and settlement cluster type, which had additionally negative effects on health for females. There were some variations observed within the Halifax Regional Municipality, suggesting the importance of further investigating a variety of health and disease outcomes at smaller area-levels than those employed in previous studies.ConclusionsThis paper highlighted the importance of further articulating the differences in the characteristics of rural at finer area-levels and the differential influence they may have on health. Further efforts are desirable to overcome various data challenges in order to extend the investigation of health inequalities to hard-to-study provinces.

Highlights

  • Efforts have been made to articulate rural–urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies

  • Metropolitan Influence Zone (MIZ) is defined at the Census Subdivision (CSD) level which usually represents municipalities, and is often used in combination with Census definitions of urban (i.e., Census Metropolitan Area and Census Agglomeration Area [census designated metropolitan area (CMA)/Census agglomeration area (CA)]) to show an urban–rural continuum

  • Area units and life expectancy at birth Nova Scotia has a set of official area units called ‘communities,’ which was designed by the Nova Scotia government for the purpose of public policy development and decision making in consultation with local planning officials to better represent generally perceived community identities [24]

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Summary

Introduction

Efforts have been made to articulate rural–urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. In the last 10 to 15 years, an increasing number of studies have started investigating inequalities in health and health behaviours between rural and urban regions. Riva and colleagues [1] pointed out that the inconsistencies in the results of comparisons may be attributed to a wide range of health measures used for comparisons, and the level of geographical detail used to define rural areas. MIZ classifies CSDs into zones (Strong-, Moderate-, Weak- and No-MIZ) based on the levels of influence by CMA/CA, measured by the proportion of commuters and geographical distance to large urban centres of 10,000 or more people [8]

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