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Open Access Highly Accessed Open Badges Research article

Is the health of people living in rural areas different from those in cities? Evidence from routine data linked with the Scottish Health Survey

P Teckle14*, P Hannaford2 and M Sutton3

Author Affiliations

1 Canadian Centre for Applied Research in Cancer Control (ARCC) "Advancing health economics, services, policy and ethics", #2-111, 675 West 10th Avenue, Cancer Research Centre, V5Z 1L3, Vancouver, BC, Canada

2 University of Aberdeen, Aberdeen, UK

3 University of Manchester, Manchester, UK

4 Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

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BMC Health Services Research 2012, 12:43  doi:10.1186/1472-6963-12-43

Published: 17 February 2012



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).

Health determinants; Rural health; Administrative data-linkage; Survey methods