The effect of modifiable risk factors on geographic mortality differentials: a modelling study

BMC Public Health

Research Article

Jonathan E Shaw¹  Dianna J Magliano¹  Helen Walls²  Christopher E Stevenson²  Anna Peeters²  John J McNeil²  Haider Mannan² 

[1] Baker IDI Heart and Diabetes Institute, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia;School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia;

关键词: Major City;    Regional Area;    High Systolic Blood Pressure;    Population Attributable Fraction;    Health Risk Factor;   

DOI  :  10.1186/1471-2458-12-79

 received in 2011-02-16, accepted in 2012-01-25,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundAustralian mortality rates are higher in regional and remote areas than in major cities. The degree to which this is driven by variation in modifiable risk factors is unknown.MethodsWe applied a risk prediction equation incorporating smoking, cholesterol and blood pressure to a national, population based survey to project all-causes mortality risk by geographic region. We then modelled life expectancies at different levels of mortality risk by geographic region using a risk percentiles model. Finally we set high values of each risk factor to a target level and modelled the subsequent shift in the population to lower levels of mortality risk and longer life expectancy.ResultsSurvival is poorer in both Inner Regional and Outer Regional/Remote areas compared to Major Cities for men and women at both high and low levels of predicted mortality risk. For men smoking, high cholesterol and high systolic blood pressure were each associated with the mortality difference between Major Cities and Outer Regional/Remote areas--accounting for 21.4%, 20.3% and 7.7% of the difference respectively. For women smoking and high cholesterol accounted for 29.4% and 24.0% of the difference respectively but high blood pressure did not contribute to the observed mortality differences. The three risk factors taken together accounted for 45.4% (men) and 35.6% (women) of the mortality difference. The contribution of risk factors to the corresponding differences for inner regional areas was smaller, with only high cholesterol and smoking contributing to the difference in men-- accounting for 8.8% and 6.3% respectively-- and only smoking contributing to the difference in women--accounting for 12.3%.ConclusionsThese results suggest that health intervention programs aimed at smoking, blood pressure and total cholesterol could have a substantial impact on mortality inequities for Outer Regional/Remote areas.

【 授权许可】

CC BY   
© Stevenson et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.