Is the health of people living in rural areas different from those in cities? Evidence from routine data linked with the Scottish Health Survey

BACKGROUND To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics. METHODS DESIGN Mortality and hospital record data linked to two cross sectional health surveys. SETTING Respondents in the community-based 1995 and 1998 Scottish Health Survey who consented to record-linkage follow-up. MAIN OUTCOME MEASURES Hypertension, all-cause premature mortality, total hospital stays and admissions due to coronary heart disease (CHD). RESULTS Older age and lower social class were strongly associated with an increased risk of each of the four health outcomes measured. After adjustment for individual and practice characteristics, no consistent pattern of better or poorer health in people living in rural areas was found, compared to primary cities. However, individuals living in remote small towns had a lower risk of a hospital admission for CHD and those in very remote rural had lower mortality, both compared with those living in primary cities. CONCLUSION This study has shown how linked data can be used to explore the possible influence of area of residence on health. We were unable to find a consistent pattern that people living in rural areas have materially different health to that of those living in primary cities. Instead, we found stronger relationships between compositional determinants (age, gender and socio-economic status) and health than contextual factors (including rurality).