An Urban-Rural Exploration of Depression, CVD and their Comorbidity in Ireland

Abstract

The significant rise in the comorbidity of physical conditions with mental disorders is increasingly recognised as a public health issue. Spatial considerations and how they interact with individual level socio-economic characteristics also play a crucial role in influencing health outcomes. To date, most hypotheses tend to assume that health outcomes will be poorer in urban rather than rural areas. The aim of this paper is to examine whether the prevalence of cardiovascular disease (CVD), depression and their comorbidity is higher across an expanded eight category classification of urban/rural areas once the known compositional determinants for both diseases are controlled for. It was found that the comorbidity of CVD and depression may be explained by individuals being exposed to spatially-variant demographic and socio-economic factors that may predispose them to both conditions. With regard to the location variables, it was found that health outcomes do not improve as space becomes increasingly rural relative to a city environment; suburban and mixed urban/rural residences bordering suburbs are consistently associated with poorer health outcomes, relative to city locations. Furthermore, residents of small towns have poorer health outcomes relative to city residents, whilst residents of large towns have better health outcomes relative to city residents. Thus, this paper concludes that health outcomes cannot be predicted on areas being dichotomously defined as rural versus urban and that non-linearities exist in health outcomes as areas become increasingly rural.