Inequalities in Rural Health Care: Differences in Surgical Intervention Between Metropolitan and Rural Western Australia

BACKGROUND: To compare surgical procedure rates between metropolitan and rural/remote residents in Western Australia (WA). METHODS: The WA Data Linkage System was used to identify all patients who underwent a procedure for cataract, ureteric calculi or urinary outflow obstruction symptoms for the time periods 1981-2000, 1981-1997 and 1981-1995, respectively. Age-standardized procedure rates were calculated and Poisson regression modelling was used to estimate effects of locality of residence and demographic covariates. RESULTS: Overall, rural/remote patients underwent first-time procedures for cataract (IRR 0.92; 95% CI 0.90-0.94), ureteric calculi (0.76; 0.72-0.80), or urinary outflow obstruction (0.71; 0.69-0.74) less frequently than patients in the metropolitan area. They were also significantly less likely to undergo multiple procedures for cataracts (0.90; 0.88-0.91) and ureteric calculi (0.69; 0.67-0.73). CONCLUSION: A distinctly reduced level of surgical intervention was found in rural patients for three generally non-life threatening conditions. The reasons for this require further investigation.