Regional variation in the survival and health of older Australian women: A prospective cohort study

Objective; Older people may act as sensitive indicators of the effectiveness of health systems. Our objective is to distinguish between the effects of socio-economic and behavioural factors and use of health services on urban-rural differences in mortality and health of elderly women. Methods: Baseline and longitudinal analysis of data from a prospective cohort study. Participants were a community-based random sample of women (n=12778) aged 70-75 years when recruited in 1996 to the Australian Longitudinal Study on Women's Health. Measures used were: urban or rural residence in Australian States and Territories, socio-demographic characteristics, health related behaviour, survival up to 1 October 2006, physical and mental health scores and use of medical services. Results: Mortality was higher in rural than in urban women (hazard ratio, HR 1.14; 95% CI, 1.03,-1.26) but there were no differences between States and Territories. There were no consistent baseline or longitudinal differences between women for physical or mental health, with or without adjustment for socio-demographic and behavioural factors. Rural women had fewer visits to general practitioners (odds ratio, OR=0.54; 95% Cl, 0.48-0.61) and medical specialists (OR=0.60; 95% Cl, 0.55-0.65). Conclusions: Differences in use of health services are a more plausible explanation for higher mortality in rural than urban areas than differences in other factors. Implications. Older people may be the 'grey canaries' of the health system and may thus provide an 'early warning system' to policy makers and governments. Journal Compilation