This article has a correction

Please see: BMJ Open 2014;4

BMJ Open 3:e003203 doi:10.1136/bmjopen-2013-003203
  • Public health
    • Research

A comparison of Australian rural and metropolitan cardiovascular risk and mortality: the Greater Green Triangle and North West Adelaide population surveys

  1. James A Dunbar4
  1. 1Integrated Cardiovascular Clinical Network, Country Health SA Local Health Network, Flinders Medical Centre, Adelaide, Australia
  2. 2Population Research and Outcome Studies, The University of Adelaide, Australia
  3. 3Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Western Hospital, Melbourne, Australia
  4. 4Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
  5. 5Queensland University of Technology, Brisbane, Australia
  6. 6National Institute for Health and Welfare, Helsinki, Finland
  7. 7Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  8. 8Integrated Cardiovascular Clinical Network, Country Health SA Local Health Network, Adelaide, Australia
  1. Correspondence to Prof James A Dunbar; director{at}
  • Received 10 May 2013
  • Revised 30 June 2013
  • Accepted 16 July 2013
  • Published 23 August 2013


Objectives Cardiovascular (CVD) mortality disparities between rural/regional and urban-dwelling residents of Australia are persistent. Unavailability of biomedical CVD risk factor data has, until now, limited efforts to understand the causes of the disparity. This study aimed to further investigate such disparities.

Design Comparison of (1) CVD risk measures between a regional (Greater Green Triangle Risk Factor Study (GGT RFS, cross-sectional study, 2004–2006) and an urban population (North West Adelaide Health Study (NWAHS, longitudinal cohort study, 2004–2006); (2) Australian Bureau of Statistics (ABS) CVD mortality rates between these and other Australian regions; and (3) ABS CVD mortality rates by an area-level indicator of socioeconomic status, the Index of Relative Socioeconomic Disadvantage (IRSD).

Setting Greater Green Triangle (GGT, Limestone Coast, Wimmera and Corangamite Shires) of South-Western Victoria and North-West Adelaide (NWA).

Participants 1563 GGT RFS and 3036 NWAHS stage 2 participants (aged 25–74) provided some information (self-administered questionnaire +/− anthropometric and biomedical measurements).

Primary and secondary outcome measures Age-group specific measures of absolute CVD risk, ABS CVD mortality rates by study group and Australian Standard Geographical Classification (ASGC) region.

Results Few significant differences in CVD risk between the study regions, with absolute CVD risk ranging from approximately 5% to 30% in the 35–39 and 70–74 age groups, respectively. Similar mean 2003–2007 (crude) mortality rates in GGT (98, 95% CI 87 to 111), NWA (103, 95% CI 96 to 110) and regional Australia (92, 95% CI 91 to 94). NWA mortality rates exceeded that of other city areas (70, 95% CI 69 to 71). Lower measures of socioeconomic status were associated with worse CVD outcomes regardless of geographic location.

Conclusions Metropolitan areas do not always have better CVD risk factor profiles and outcomes than rural/regional areas. Needs assessments are required for different settings to elucidate relative contributions of the multiple determinants of risk and appropriate cardiac healthcare strategies to improve outcomes.

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