title: Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage.
abstract: OBJECTIVE
  We examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia.
  
  
  METHODS
  A population-based cohort study.
  
  
  METHODS
  Hospitalised patients in Western Australia, Australia.
  
  
  METHODS
  Index patients aged 20-84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data.
  
  
  METHODS
  30-day and 1-year all-cause mortality (in 30-day survivors) following index admission for HF.
  
  
  RESULTS
  Of 17 379 index patients with HF identified, 25.9% (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9% of metropolitan and 17.2% of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20%) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95% CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95% CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the 'c' statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.
  
  
  CONCLUSIONS
  Remoteness and variable access to healthcare can cause important disparities in health outcomes. Rural patients with HF in Western Australia have poorer risk-adjusted outcomes compared with metropolitan patients. This finding has important implications for chronic disease management and provision of health services in rural Australia.
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Tiew-Hwa Katherine
authors.initials: TH
authors.lastname: Teng
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbs
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008875:Middle Aged; D012423:Rural Health; D013997:Time Factors; D014504:Urban Health; D014904:Western Australia; D055815:Young Adult
keywords: Epidemiology