Evidence map›Paper›PMID 37055208›Full record

Observational studyBMJ open2023

Unmasking hidden disparities: a comparative observational study examining the impact of different rurality classifications for health research in Aotearoa New Zealand.

Jesse Whitehead, Gabrielle Davie, Brandon de Graaf, Sue Crengle, Ross Lawrenson, Rory Miller, Garry Nixon

Abstract readComparative StudyObservational Study
In one paragraph

Observational study in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jesse WhiteheadDepartment of General Practice and Rural Health, University of Otago, Dunedin, New Zealand Jesse.whitehead@waikato.ac.nz.ORCID 0000-0001-9682-7544
Gabrielle DavieDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.ORCID 0000-0001-5466-5364
Brandon de GraafDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Sue CrengleDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.ORCID 0000-0001-9367-1492
Ross LawrensonWaikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand.
Rory MillerDepartment of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.ORCID 0000-0002-4221-6892
Garry NixonDepartment of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesExamine the impact of two generic-urban-rural experimental profile (UREP) and urban accessibility (UA)-and one purposely built-geographic classification for health (GCH)-rurality classification systems on the identification of rural-urban health disparities in Aotearoa New Zealand (NZ).

designA comparative observational study.

settingNZ; the most recent 5 years of available data on mortality events (2013-2017), hospitalisations and non-admitted hospital patient events (both 2015-2019).

participantsNumerator data included deaths (n PRIMARY AND SECONDARY OUTCOME MEASURES: Primary measures were the unadjusted rural incidence rates for 17 health outcome and service utilisation indicators, using each rurality classification. Secondary measures were the age-sex-adjusted rural and urban incidence rate ratios (IRRs) for the same indicators and rurality classifications.

resultsTotal population rural rates of all indicators examined were substantially higher using the GCH compared with the UREP, and for all except paediatric hospitalisations when the UA was applied. All-cause rural mortality rates using the GCH, UA and UREP were 82, 67 and 50 per 10 000 person-years, respectively. Rural-urban all-cause mortality IRRs were higher using the GCH (1.21, 95% CI 1.19 to 1.22), compared with the UA (0.92, 95% CI 0.91 to 0.94) and UREP (0.67, 95% CI 0.66 to 0.68). Age-sex-adjusted rural and urban IRRs were also higher using the GCH than the UREP for all outcomes, and higher than the UA for 13 of the 17 outcomes. A similar pattern was observed for Māori with higher rural rates for all outcomes using the GCH compared with the UREP, and 11 of the 17 outcomes using the UA. For Māori, rural-urban all-cause mortality IRRs for Māori were higher using the GCH (1.34, 95% CI 1.29 to 1.38), compared with the UA (1.23, 95% CI 1.19 to 1.27) and UREP (1.15, 95% CI 1.10 to 1.19).

conclusionsSubstantial variation in rural health outcome and service utilisation rates were identified with different classifications. Rural rates using the GCH are substantially higher than the UREP. Generic classifications substantially underestimated rural-urban mortality IRRs for the total and Māori populations.

Indexed as

EthnicityPopulation GroupsHumansMaori PeopleNew ZealandRural PopulationEPIDEMIOLOGYHealth policyPUBLIC HEALTHSTATISTICS & RESEARCH METHODS

Identifiers

PMID37055208
PMCPMC10106021

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.