Incidence of major health events across metropolitan and regional areas: A 10+ year prospective study of 16,697 older Australians
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Date
2025
Authors
Farbotko, S.
Owen, A.
Orchard, S.G.
Woods, R.L.
Nelson, M.
Stocks, N.P.
Tonkin, A.
Wolfe, R.
McNeil, J.
Gibbs, P.
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Journal article
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Australasian Journal on Ageing, 2025; 44(2):e70036-1-e70036-10
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Shay Farbotko, Alice Owen, Suzanne G. Orchard, Robyn L. Woods, Mark Nelson, Nigel P. Stocks, Andrew Tonkin, Rory Wolfe, John McNeil, Peter Gibbs, John Zalcberg, Joanne Ryan
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Abstract
Objective: To examine the prevalence of health risk factors by rurality status and the association of rurality and incidence of disability-free survival (DFS), its components (death, dementia and physical disability), cardiovascular disease (CVD), cancer and underlying cause of death. Methods: Data came from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and observational extension, ASPREE-XT. Community-dwelling Australians aged 70 years or older, with no prior CVD events, dementia or independence-limiting physical disability, were recruited through General Practitioners between 2010 and 2014. Area of residence was classified as major cities, inner regional or outer regional/remote. Major incident health events were adjudicated by expert panels. Results: Participants (n = 16,697, median age 74 years; 55% female) were followed over a median 8.3 years. A small, but statistically significant higher prevalence of many health risk factors was found for individuals living outside metropolitan areas. Rurality was not associated with the incidence of DFS, dementia, physical disability or CVD events in adjusted Cox proportional hazards regression models. Compared to major cities, individuals in outer regions/remote areas had an increased risk of all-cause death (HR: 1.17; 95% CI 1.02, 1.34) which appeared to be driven by fatal CVD (HR: 1.40; 95% CI 1.02, 1.83), while those in inner regions had a lower cancer incidence (HR: .89; 95% CI .82, .98). Conclusions: Incidence of DFS, dementia and physical disability did not differ according to rurality. Heightened risk of mortality was evident outside urban areas, possibly reflecting inequitable health service and access. Lower cancer incidence in inner regions requires further investigation.
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© 2025 The Author(s). Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.