The Influence of Rurality on Cardiovascular Health

Heath Darrant and Prof Joseph Suttie

Introduction

Systemic arterial hypertension (HTN) has been classified as a leading modifiable risk factors for all-cause mortality, with majority of patients deteriorating asymptomatically. For a patient to be classified as hypertensive, they must have at least one of the following readings, a systolic BP above 140mmHg or a diastolic BP above 90mmHg. The Australian Bureau of Statistics health Survey estimates 34% of Australians suffer from hypertension, with rates being higher in Rural Australia. It is reported rural residents are 90% more likely to experience fatal cardiovascular events due to HTN than metropolitan residents. 

Current studies show factors such as male sex, increasing age, smoker, obesity, diabetes, ethnicity, family history and many more, all place someone at risk of developing hypertension. However, no literature has explored the influence rurality has on HTN. 

Methodology

In total, 2022 patients were analysed in this retrospective cross-sectional study. All patients were treated at Riverina Cardiology from 2012-2022; and resided within the Murrumbidgee Local Health District. Consent was obtained from all patients before data collection.  The data was analysed using SPSS. 

Results

When analysing the influence geographical remoteness has on blood pressure, no correlation was observed when analysing HTN as a categorical variable. However, when analysed as continuous data, increased geographical remoteness was independently associated both systolic and diastolic HTN, β = 0.052, and β = 0.024, respectively. 

Whilst the β co-efficient for the influence of distance on BP is only small, standardisation (β = 0.14) shows it has approximately the same influence as BMI and Sex, β = 0.154 and β = 0.119 respectfully. It also has a higher influence compared to hypercholesterolaemia, β = 0.058. 

Hypertension was also found to be associated with increased rates of thoracic aortopathies, OR 1.29 (CI 95% 1.07-1.55). 

Conclusion

The results above highlight the need for further investigation into the effects rurality alone has on cardiovascular health. This study also allows room for further investigation into the possible compounding effects of travel time and cost on disease prevalence and health outcomes.