Background:
Rural Australians experience higher mortality from cardiovascular disease (CVD), and especially from ischaemic heart disease (IHD), when compared to metropolitan counterparts. CVD risk factors are known to differ by rurality but little is known about how these differences contribute to the increased rural CVD and IHD burden. Aims: (1) to quantify differences in modifiable risk factors between urban and rural populations, and (2) to determine the number of rural CVD and IHD deaths that could be averted or delayed if risk factor levels in rural areas were equivalent to metropolitan areas.
Design:
A macro-simulation modelling study.
Methods:
National population estimates, risk factor prevalence, CVD and IHD deaths data were analysed by rurality using the Preventable Risk Integrated Model (PRIME) macro-simulation chronic disease risk model. Uncertainty analysis was conducted using a Monte Carlo simulation of 10,000 iterations to calculate 95% credible intervals (CI).
Results:
If people living in rural Australia had the same levels of risk factors as those in metropolitan areas, approximately 1458 (95% credible interval (CI): 1088, 1803) deaths could be delayed from cardiovascular disease (CVD) annually. Of these CVD deaths, 793 (95%CI: 506, 1065) would be from IHD. The IHD mortality gap between metropolitan and rural populations would be reduced by 38.2% (95%CI: 24.4%, 50.6%).
Conclusions:
A significant portion of deaths from CVD and IHD could be averted with improvements in risk factors; more than one third of the excess IHD deaths in rural Australia were attributed to differences in risk factors. As much as two thirds of the increased IHD mortality rate in rural areas could not be accounted for by modifiable risk factors, however, and this requires further investigation.