Cardiovascular risk levels in general practice patients with type 2 diabetes in rural and urban areas.
OBJECTIVE
To investigate the change of cardiovascular risk factor from 2000 to 2002 in general practice patients with type 2 diabetes in urban and rural areas, and the association between cardiovascular risk (both single risk factors and coronary heart disease absolute risk (CHDAR)) and rurality in three years.


METHODS
In total, 6305 patients were extracted from 16 Divisions (250 practices). Multivariate regression at Division, practice and patient levels was conducted with adjustment for age and gender.


RESULTS
In each of the three years, most single individual risk factors and CHDAR were high. Comparing 2002 with 2000: for urban patients in 2002 total cholesterol (OR 0.85) and low-density lipoprotein (OR 0.81) significantly decreased, and high-density lipoprotein (HDL) (OR 1.16) significantly increased; for rural patients in 2002 HbA1c (OR 0.85) significantly decreased and HDL (OR 1.22) significantly increased; and CHDAR significantly improved only in urban patients (OR 0.93) in 2002. In 2002 rural patients were still more likely to be overweight/obese (OR 1.16), be current smokers (OR 1.36), and have worse HDL (OR 0.84) and triglycerides (OR 1.23) than their urban counterparts.


CONCLUSIONS
Some key individual risk factors and CHDAR did not improve in rural patients with type 2 diabetes despite a number of programs designed to provide comprehensive care to rural patients with diabetes. More emphasis is needed on supporting access to lifestyle changes (such as smoking, diet and physical activity) in rural primary health care.
Wan
Qing
Q
Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Harris
Mark F
MF
Powell-Davies
Gawaine
G
Jayasinghe
Upali W
UW
Flack
Jeff
J
Georgiou
Andrew
A
Burns
Joan R
JR
Penn
Danielle L
DL
D000368:Aged; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D003191:Comprehensive Health Care; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005194:Family Practice / Q000639:trends*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008019:Life Style; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D009765:Obesity / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D012423:Rural Health / Q000639:trends*; D012907:Smoking / Q000453:epidemiology; D017749:Total Quality Management / Q000458:organization & administration; D014504:Urban Health / Q000639:trends*