Influence of the definition of rurality on geographic differences in HIV outcomes in British Columbia: a retrospective cohort analysis

Abstract

I n Canada, health inequities have been well documented in rural, remote and northern areas. As a result, improving rural health is often a priority area for health research and service delivery. For example, rural, remote and northern areas in Canada have been found to have higher rates of all-cause mortality, chronic kidney disease, obesity, cerebrovascular disease and maternal morbidity. 1-4 In addition to higher incidence and prevalence of chronic diseases, disease-specific outcomes and use of evidence-based therapies are poorer in rural areas. 5-7 Infection with HIV is a chronic disease with many reported geographic discrepancies in care in high-income countries. With appropriate care and medications, the life expectancy of those living with HIV can approach that of the general population. 8 Despite advances in HIV care, people in rural areas experience more advanced disease at diagnosis, delayed linkage to care, more rapid disease progression and increased mortality. 9-14 The relation between rurality and health outcomes is complex and is driven by intersecting determinants, including poverty, education, industries that extract natural resources, colonialism, health human resources and travel distances. 15-21 Further complicating health analyses on rurality are heterogeneity among rural areas, varying definitions of rurality and authors' failure to justify selected definitions. 22,23 In Canada, common definitions rely on population census categorizations, postal codes or rurality indices. 24-26

Is the association between sexual minority status and suicide-related behaviours modified by rurality? A discrete-time survival analysis using longitudinal health administrative data

“…Unlike the RIO and MIZ, the IR was created for use as a continuous measure of rurality and will therefore be used continuously in this study. A continuous measure of rurality such as the IR recognizes the complexity of the urbanrural continuum by representing the degree of rurality, rather than whether an area is urban or rural 61 .…”

Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency

“…The SAC provides an ordinal classification from 1 to 7 by size and degree of metropolitan influence. 2 The residential SAC associated with each surgery was obtained by linking DSAEK recipients' postal code to census subdivision using the Statistics Canada Postal Code Conversion File (accessed on September 16, 2022). Individuals living in census subdivisions with a SAC code of 4 or greater were defined as residing in a rural and small town (RST) setting, whereas those with SAC codes 1 through 3 (metropolitan and agglomeration areas) were assigned a non-RST or urban status.…”

Is the association between sexual minority status and suicide-related behaviours modified by rurality? A discrete-time survival analysis using longitudinal health administrative data

“…education and cultural centres). Prior studies on geographic differences in Canadian health outcomes have used MIZs as they capture varying degrees of rurality 61 . All municipalities (represented by CSDs) in Ontario are classified based on the proportion of individuals who have to commute to population centres.…”