Rural Inequalities in the Australian Burden of Ischaemic Heart Disease: A Systematic Review.
OBJECTIVE
To summarise all available evidence on the differences in burden of ischaemic heart disease (IHD) between metropolitan and rural communities of Australia.


METHODS
Systematic review of peer-reviewed literature published between 1990 and 2014. Search terms were derived from the four major topics: (1) rural; (2) ischaemic heart disease; (3) Australia; and (4) burden of disease. Terms were adapted for six databases and two independent researchers screened results. Studies were included if they compared outcomes related to IHD in adults aged 18 years and over, between (at least) two areas of differing remoteness, at the same point in time.


RESULTS
Twenty studies were included and presented data collected between 1969 and 2010. Seventeen studies showed a clear disparity in IHD outcomes between major cities and regional and remote areas, with a consistently higher burden observed outside major cities. Among Aboriginal and Torres Strait Islander populations, fewer differences were observed and some IHD outcomes were not associated with remoteness.


CONCLUSIONS
Populations outside of major cities in Australia bear a disproportionately high burden of ill health due to IHD, yet the majority of the rural populations are yet to be investigated in terms of burden of disease outcomes from IHD.


CONCLUSIONS
Remoteness is a key determinant of IHD burden in Australia. The reasons for increased IHD burden in rural compared to metropolitan communities of Australia are poorly understood, which has implications for the design of targeted interventions to reduce geographical inequalities.
World Health Organisation Collaborating Centre for Obesity Prevention, Deakin University, Geelong Waterfront campus, Geelong, Vic, Australia. Electronic address: laura.alston@deakin.edu.au.
Laura
L
Alston
World Health Organisation Collaborating Centre for Obesity Prevention, Deakin University, Geelong Waterfront campus, Geelong, Vic, Australia.
Steven
S
Allender
World Health Organisation Collaborating Centre for Obesity Prevention, Deakin University, Geelong Waterfront campus, Geelong, Vic, Australia.
Karen
K
Peterson
World Health Organisation Collaborating Centre for Obesity Prevention, Deakin University, Geelong Waterfront campus, Geelong, Vic, Australia.
Jane
J
Jacobs
World Health Organisation Collaborating Centre for Obesity Prevention, Deakin University, Geelong Waterfront campus, Geelong, Vic, Australia.
Melanie
M
Nichols
D000328:Adult; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D012424:Rural Population; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
Burden; Heart disease; Inequality; Rural