Aotearoa's rural populations die at higher rates than those living in urban centres, according to a new University of Otago (UoO) study.
The findings published this morning contradict existing data on death rates across geographical settings, with researchers calling it "the strongest evidence yet that New Zealanders who live in rural areas have poorer health outcomes".
The research showed mortality rates among Māori were disproportionately higher. (Source: Breakfast)
In a media release, lead author Professor Garry Nixon said the study - published in the Journal of Epidemiology and Community Health - is the first to show a consistent pattern of higher mortality rates for rural populations.
"We believe this study is more accurate than others," he argued, "it uses recent data, it uses a definition of rural that was developed with health in mind and validated for that purpose, and importantly, it considers each age group separately."
The research used geographical classification designed for health policy and research, where all of New Zealand's land area was divided into five categories - two urban and three rural - and ranked from most urban to most rural.
The study analysed the age, sex, ethnicity and cause of just over 160,000 deaths registered between 2014 and 2018 by the Ministry of Health and Statistics New Zealand.
Types of deaths were placed in five categories: All-cause, amenable i.e. possibly avoidable, cardiovascular, cancer, and injury.
Mortality rates in rural areas were found to be higher than urban areas across all age groups under 60, the largest disparities being for those under 30 where the death rate was 599 per 100,000 in the most urban area, compared to 1085 in the most rural.
When causes were analysed, rural death rates most greatly outpaced urban ones when it came to injury and amenable deaths.
Co-author Professor Sue Crengle highlighted that rural Māori mortality rates were not only higher than urban rates, but rural non-Māori rates as well. In the most rural area, the Māori mortality rate were 4018 per 100,000, compared to 3055 per 100,000 for non-Māori.
The disparity was flipped among those aged over 75, as rural non-Māori had smaller mortality rates compared to urban residents, while rural Māori had a very similar mortality rate.
'We need to dive deeper into disparities'
Speaking with 1News, Nixon said the study's findings were significant, but more research was needed to understand why higher mortality rates exist in rural areas.
He noted that Aotearoa's higher rural mortality rates reflected similar patterns seen in Australia and the US, but differed from higher-density populations seen in some European countries.
"In those countries, you tend to find rural health outcomes are better than urban areas and the city," he said, "we align more with countries in Scandinavia or places like Australia that have low population densities."
Though he could not say definitively so, Nixon figured the higher amenable and injury-based deaths in rural parts could be linked to dangerous occupations, precarious roads and potentially a higher suicide rate.
"There is of course also the access to primary and secondary healthcare, which can be problematic in rural areas," he said.
He said further research would look into the causes behind the disparities, such as socioeconomic statuses, the ability to "buy a way out" of health issues, and the tendency for older rural generations to shift to cities for retirement care.
The results will be used to inform the Rural Health Strategy being developed by Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora (Māori Health Authority).
"The goal of the research is to work with the health system and guide it on what to do about [mortality rates]", Nixon said.
"This has important health policy implications in a country where rural health outcomes have been assumed to be as good, if not better, than those in urban areas."
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