Highlights
- •Remoteness was not associated with substantial worse health outcomes in Australia.
- •Those living in inner regional areas having slightly worse health outcomes.
- •Those living in inner regional areas were less likely to use high efficacy DMTs.
- •Migration for improved treatment access may have reduced the effect sizes.
Abstract
Background
Little is known about whether living in remote areas is associated with worse health
outcomes in Australians with MS.
Objectives
To evaluate whether living in remote areas was associated with worse health outcomes,
employment outcomes and different disease modifying therapy (DMTs) utilisation among
Australians with MS.
Methods
We included 1,611 participants from the Australian MS Longitudinal Study. Level of
remoteness (major cities, inner regional, outer regional, remote, and very remote
Australia) was determined using postcode. Data were analysed using linear, log-binomial,
log-multinomial and negative binomial regression.
Results
Living in more remote areas was not associated with substantial worse health/employment
outcomes. There was a consistent pattern of those living in inner regional areas having
worse outcomes, but the effect sizes were relatively small with no clear dose-response
relationships with increasing remoteness. Those living in more remote areas were less
likely to use high efficacy DMTs. Adjusting for age, disease duration, and education
level only marginally reduced the associations.
Conclusions
There is no large inequity in health outcomes in the Australian MS population due
to remoteness. However, modest and consistent differences in health outcomes and DMTs
treatment are likely to have a substantial cumulative impact at an individual level.
Keywords
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Article info
Publication history
Published online: August 09, 2021
Accepted:
August 8,
2021
Received in revised form:
July 20,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
