A comparison of the modelled impacts on CVD mortality if attainment of public health recommendations was achieved in metropolitan and rural Australia

Abstract

Objective: To (i) determine the proportion of deaths from CVD that could be avoided in both rural and metropolitan Australia if public health recommendations were met; (ii) assess the impact on the rural CVD mortality; and (iii) determine if policy priorities should be different by rurality for CVD prevention.

Design: A macro-simulation modelling study of population data. Population, risk factor and CVD death data stratified by rurality were analysed using the Preventable Risk Integrated Model. The baseline scenario was the current risk factor levels (including physical activity, smoking, diet and alcohol). The counterfactual scenario was the population levels of these risk factors expected if public health recommendations were met.

Setting: Metropolitan and rural Australia.

Participants: Rural- and metropolitan-dwelling adults in Australia.

Results: Both populations would experience similar relative declines in the proportion of deaths from CVD. A total of 14 892 deaths from CVD would be avoided annually; with similar declines in the proportions of deaths by rurality. Critically, the order of policy priorities for public health recommendation attainment would differ by rurality CVD prevention, with addressing fat intakes being a higher priority in rural areas.

Conclusions: Achieving public health recommendations in Australia would result in large declines in CVD mortality. Despite declines in overall CVD mortality under this scenario, an inequality in CVD burden would persist for rural populations. The order of risk factor priorities would differ by rurality.

Keywords: CVD; Dietary intake; IHD; Inequalities; Prevention; Risk factors; Rural.

Fig. 1

Proportions of total (a) CVD deaths and (b) IHD deaths saved by rurality (, metropolitan areas; , rural areas) and public health recommendation under the counterfactual scenario that the population achieved the level of modifiable risk factors recommended for optimal public health in Australia

Fig. 2

Deaths per 100 000 from CVD and IHD by rurality (, metropolitan areas; , rural areas) at baseline and under the counterfactual scenario that the population achieved the level of modifiable risk factors recommended for optimal public health in Australia. See online supplementary material, Supplemental Table S2, for full data and breakdown by sex (diff, absolute difference in death rates per 100 000 between rural and metropolitan areas; RR, relative risk)