A comparison of Australian rural and metropolitan cardiovascular risk and mortality: the Greater Green Triangle and North West Adelaide population surveys

Design: 
Comparison of (1) CVD risk measures between a regional (Greater Green Triangle Risk Factor Study (GGT RFS, cross-sectional study, 2004–2006) and an urban population (North West Adelaide Health Study (NWAHS, longitudinal cohort study, 2004–2006); (2) Australian Bureau of Statistics (ABS) CVD mortality rates between these and other Australian regions; and (3) ABS CVD mortality rates by an arealevel indicator of socioeconomic status, the Index of Relative Socioeconomic Disadvantage (IRSD).

Setting: 
Greater Green Triangle (GGT, Limestone Coast, Wimmera and Corangamite Shires) of South-Western Victoria and North-West Adelaide (NWA).

Participants:
1563 GGT RFS and 3036 NWAHS stage 2 participants (aged 25–74) provided some information (self-administered questionnaire +/−anthropometric and biomedical measurements).

Primary and secondary outcome measures:

Age-group specific measures of absolute CVD risk, ABS CVD mortality rates by study group and Australian Standard Geographical Classification (ASGC) region.

Results:
Few significant differences in CVD risk between the study regions, with absolute CVD risk ranging from approximately 5% to 30% in the 35–39 and 70–74 age groups, respectively. Similar mean 2003–2007 (crude) mortality rates in GGT (98, 95% CI 87 to 111), NWA (103, 95% CI 96 to 110) and regional Australia (92, 95% CI 91 to 94). NWA mortality rates exceeded that of other city areas (70, 95% CI 69 to 71). Lower measures of socioeconomic status were associated with worse CVD outcomes regardless of geographic location.

Conclusions:
Metropolitan areas do not always have better CVD risk factor profiles and outcomes than rural/regional areas. Needs assessments are required for different settings to elucidate relative contributions of the multiple determinants of risk and appropriate cardiac healthcare strategies to improve outcomes.