Differences in health for rural and urban Canadians

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Mortality rates higher in most rural areas, but cancer incidence rates lower

September 19, 2006 – A new report released today shows that Canadians living in rural areas generally have higher mortality (or death) rates than those living in urban areas. How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants is the result of a research partnership between the Canadian Population Health Initiative (CPHI)-a part of the Canadian Institute for Health Information (CIHI)-as well as the Public Health Agency of Canada (PHAC) and the Centre for Rural and Northern Health Research (Laurentian University). This report provides a new pan-Canadian perspective on the health of rural Canadians. The report compares urban areas with four types of rural areas: those with highest commuting flow (where at least 30% of employed people commute to an urban area to work) and areas with moderate, weak, and no commuting flow.

Researchers found that Canadians living in rural and remote areas had higher death rates than their urban counterparts. Annual mortality rates were highest in the most rural areas (with no commuters) at 792 deaths per 100,000 people compared to 695 deaths per 100,000 in urban areas. However, rural areas with the highest commuting flow had lower mortality rates (at 668 deaths per 100,000 people) than urban areas. The urban�rural difference in mortality was most pronounced among children and adolescents aged 5 to 19, particularly for deaths due to injuries.

�Higher overall mortality rates among rural communities seem to be driven by higher death rates from causes such as circulatory diseases and injuries,� says Marie DesMeules, one of the Principal Investigators of the study. �Circulatory diseases are the leading cause of death in Canada. Our analysis shows that risk factors such as smoking and obesity are reported more frequently among rural than urban residents, and this may contribute to the higher risk of dying prematurely from circulatory disease among rural and remote residents.�

Major causes of death

Rural residents had increased risk of dying from circulatory disease, respiratory disease, diabetes, injuries and suicide. In general, death rates were highest in areas with moderate, weak and no commuter flow. For example, death rates from circulatory disease ranged from 290 to 302 per 100,000 in areas with moderate flow to those with no commuter flow, compared with 273 per 100,000 in urban areas. For respiratory disease, among rural men aged 45 to 64 in areas with no commuters, there were 47 deaths per 100,000 compared to 33 per 100,000 in urban areas, representing a 42% higher risk of death. Men in the same age group in areas with moderate commuter flow had only a 10% higher risk of death than their urban counterparts.

Women living in areas with moderate, weak and no commuter flow generally had a higher risk of dying from diabetes compared to urban women. However, men in areas with the highest commuting flow had a lower risk of dying of diabetes than urban men.

  • Mortality rates due to motor vehicle-related injuries were higher in the most rural areas for all ages, with risks being two to three times higher than in urban areas.
  • In Canada, the overall suicide rate was 5 deaths per 100,000 people aged 5 to 19. Those under age 20 living in the most rural areas (no commuters) had the highest risk of dying from suicide-boys were four times and girls were six times more likely to commit suicide than their urban counterparts.

The rural advantage: cancer rates

The report also highlights health advantages for Canada�s rural residents. Canadians in rural areas were less likely to be diagnosed with a new case of cancer than their urban counterparts. The rate of annual cancer diagnoses ranged from 419 to 456 per 100,000 rural men as compared to 464 for urban men, and 303 to 324 per 100,000 rural women as compared to 336 for urban women. Death rates due to cancer were lower in rural populations for some specific cancers. For instance, mortality rates for breast cancer in rural women aged 45 years and older were lower than in urban areas. For women aged 45 to 64 in rural areas, breast cancer mortality ranged from 51 to 54 deaths per 100,000 as compared to 61 deaths per 100,000 in urban areas. However, rural populations were not advantaged for all types of specific cancers. For example, both incidence and mortality rates for cervical cancer were higher for women in some rural areas than in urban areas, with the highest rates found in the most rural areas. Men aged 45 to 64 living in areas with moderate and no commuter flow had higher mortality from lung cancer (123 and 125 deaths per 100,000, respectively) than men of the same age living in urban areas (109 per 100,000). This was not the case for rural women in this age group, whose lung cancer rates did not differ from those of urban women.

Higher smoking rates but stronger sense of community belonging

Smoking rates, second-hand smoke exposure and eating five servings or more of fruit and vegetables each day showed urban�rural differences. Higher proportions of rural Canadians were smokers (most rural: 32%; urban: 25%), and only 31% in the most rural areas reported eating five or more servings of fruit and vegetables each day compared to 38% of urban dwellers. Rural Canadians were also more likely to report being overweight or obese (having a body mass index of 25 or greater): 57% in the most rural areas as compared to 47% of urban Canadians.

On the other hand, living in rural areas had its advantages in terms of quality of life. Rural residents reported having lower levels of stress and a stronger sense of community belonging than their urban counterparts.

Other interesting findings:

  • For men, life expectancy at birth was generally lower in rural areas compared to urban areas, ranging from 74.0 years in the most rural areas to 76.8 years in urban areas. For women, life expectancy was about the same in urban and rural areas.
  • A higher prevalence of arthritis/rheumatism was found among rural Canadians (18% in the most rural areas) than urban Canadians (15%).
  • Compared to urban residents (28%), higher proportions of people living in rural areas reported not having graduated from secondary school (43% in the most rural areas). Those living in the most rural areas also more frequently reported an income in the lowest income category or the lower-middle income category than their urban counterparts.

�Canadians enjoy a very high standard of living compared to other countries, but some groups experience better or worse health status and health risks,� says Elizabeth Gyorfi-Dyke, Director of the Canadian Population Health Initiative. �Over 95% of Canada�s land mass is rural and is populated by one-fifth of Canadians. This research shows differences between urban and rural Canadians for several health-related factors. The information in this report gives us a starting point to look at rural health issues, including potential areas for future research on the role of place in people�s health.�

The second part of How Healthy Are Rural Canadians?, focusing on health services in rural areas, will be released in early 2007.

The Canadian Population Health Initiative (CPHI)

The Canadian Population Health Initiative is part of the Canadian Institute for Health Information (CIHI). CPHI�s mission is to foster a better understanding of the factors that affect the health of individuals and communities and to contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians. CPHI will also be releasing a report on urban health in November 2006.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada�s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI�s goal: to provide timely, accurate and comparable information. CIHI�s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca

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About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada�s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI�s goal: to provide timely, accurate and comparable information. CIHI�s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca