Urban-rural differences in self-reported limiting long-term illness in Scotland

Background Previous research suggests that there are significant differences in health between urban and rural areas. The aim of this study is to describe the pattern and magnitude of urban-rural variation in health in Scotland and to examine the factors associated with health inequalities in urban and rural areas. Methods The data used in this study were limiting long-term illness (LLTI) and socio-economic data collected by the 1991 Census. A rurality indicator was created using Scottish Household Survey rurality classifications. Multilevel Poisson regression modelling was carried out with LLTI as a health indicator for each type of rurality Within Scotland. A variety of socio-economic factors were investigated for each rurality. Results Areas with the highest Standardized Illness Ratios (SIRs) (>125) are predominantly urban whereas the lowest SIRs (<75) are found in both urban and rural areas. Rural communities are more heterogeneous than urban areas in terms of their social make-up with relation to health; however, when these areas are split according to minor road length and different socio-economic factors are added, the model fit for each new model is improved and the reduction in total variation is comparable with that of the urban models. Conclusion These findings suggest that rural areas should not be treated as a homogeneous group but should be subdivided into rural types.