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The authors declare that they have no competing interests.
PT This study was conducted as part of a PhD thesis by PT. PT developed the idea for the study and conducted all aspects of the study under the supervision of PH and MS. PT's PhD was funded by the Chief Scientist Office of the Scottish Executive Department of Health. PH is funded by NHS Grampian. MS was funded by the Chief Scientist Office. All authors were involved in the final review of the manuscript and all authors read and approved the final manuscript.
To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics.
Design: Mortality and hospital record data linked to two cross sectional health surveys. Setting: Respondents in the community-based 1995 and 1998 Scottish Health Survey who consented to record-linkage follow-up. Main outcome measures: Hypertension, all-cause premature mortality, total hospital stays and admissions due to coronary heart disease (CHD).
Older age and lower social class were strongly associated with an increased risk of each of the four health outcomes measured. After adjustment for individual and practice characteristics, no consistent pattern of better or poorer health in people living in rural areas was found, compared to primary cities. However, individuals living in remote small towns had a lower risk of a hospital admission for CHD and those in very remote rural had lower mortality, both compared with those living in primary cities.
This study has shown how linked data can be used to explore the possible influence of area of residence on health. We were unable to find a consistent pattern that people living in rural areas have materially different health to that of those living in primary cities. Instead, we found stronger relationships between compositional determinants (age, gender and socio-economic status) and health than contextual factors (including rurality).