Non-communicable disease and injury-related mortality in rural and urban places of residence: a comparison between Canada and Australia.

BACKGROUND Few published studies looking at cross-national comparisons of rural-urban health status are available. As a first step towards addressing the lack of information on how rural populations in Canada compare with rural populations elsewhere in the world, this paper examines and contrasts Canadian mortality risks of selected diseases in rural and urban areas with those of Australia. METHODS Age-standardized mortality ratios for selected causes of deaths were calculated at the national level and broken down into place of residence categories using country-specific definitions of rurality (Metropolitan Influence Zones in Canada and the Australian Standard Geographical Classification [ASGC] Remoteness in Australia). RESULTS Patterns of rural-urban mortality risk were mostly similar in both countries. However, depending on the causes of death examined, important differences were found. Mortality from motor vehicle accidents, suicide and a few cancer sites showed similar urban-rural gradients in both Canada and Australia. Notable differences were found for diabetes, all cancers combined, as well as lung and colorectal cancer. Rural Australians were at higher risk of dying from these diseases than their urban counterparts, whereas rural Canadians were at lower risk than urban Canadians. DISCUSSION Overall, the patterns that have emerged from this comparison of Canadian and Australian mortality risks suggest that health status disparities between rural and urban populations are not limited to a specific country or region of the world. However, there are also important differences between the two countries, as the geographic mortality patterns varied according to sex and according to disease category. This analysis is an initial step in promoting discussion of rural health in an international context.