From February 2017, information about the work of the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow is available and updated on the University of Glasgow website.

Urban/Rural Inequalities in Health

Previous research has suggested that there are significant differences in health between urban and rural areas. Health inequalities between the deprived and affluent in Scotland have been rising over time. We have examined health inequalities between deprived and affluent areas of Scotland for differing levels of rurality and how these have changed over time. We found that standardised all cause death rates were greater in urban areas than remote rural areas of Scotland for all levels of deprivation in 2001. The rise in inequalities between 1981 and 2001 was greatest in remote rural Scotland. In 2001 inequalities among those aged over 64 in remote rural Scotland were greater than those of the equivalent urban population at this time. This was primarily due to relatively large ratios for Ischaemic Heart Disease (IHD) and cancer amongst the remote rural elderly population. Socio-economic inequalities amongst the elderly rose over the 20 years studied and were highest in remote rural Scotland in 1998-2001. There is clearly a need to monitor the health of elderly populations.

Urban/rural differences in suicide
Although suicide accounts for a small percentage of all deaths in Scotland (1.4% in 1999), this percentage has been increasing steadily over the last two decades. In the US, Australia and England and Wales the greatest rises in suicide were seen in rural areas. We described the pattern and magnitude of urban/rural variation in suicide in Scotland, examined how methods of suicide varied according to geography, and looked at trends in suicides over time. We showed that the highest rates of suicide in 1995-99 were seen in remote rural areas. The risk of male suicide was higher in remote rural areas relative to urban areas and there was a lower risk of female suicide in accessible rural areas than in other types of area. The method of suicide varied across ruralities for both males and females. The steepest rises in suicide amongst men, adjusting for age and deprivation, were in accessible rural areas; however, the rates remained highest in remote rural areas.
Urban/rural differences in Ischaemic Heart Disease (IHD)
We also examined urban/rural variation in IHD in Scotland  which allowed us to explore the relationship between health, rurality and deprivation. Between 1981 and 1999, we studied a population aged 40-74 using three IHD health indicators: mortality, hospital stays, mortality in hospital and within 28 days of discharge (MWDH). We found that remote rural areas experienced similar IHD mortality to urban areas after adjusting for age, sex and deprivation. However, remote rural areas had significantly lower hospital discharge rates and higher mortality in hospital or following discharge. Low rates of mortality and hospitalisation in remote rural areas mask cause for concern regarding the health of rural populations.
This project was originally led by Kate Levin.



Levin K A, Leyland AH. A comparison of health inequalities in urban and rural Scotland. Social Science & Medicine 2006;62:1457-1464


Levin K A, Leyland AH. Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999. American Journal of Public Health 2006;96:145-151



Levin K A, Leyland AH. Urban/rural inequalities in suicide in Scotland, 1981-1999. Social Science & Medicine 2005;60:2877-2890



Levin K A. Urban-rural differences in self reported limiting long term illness in Scotland. Journal of Public Health Medicine 2003;25:288-294


Project Staff

External Collaborators


  • IHD Ischaemic Heart Disease
  • Ischaemic heart disease (IHD) Inadequate flow of blood through the coronary arteries to the heart.
  • Standardised A process by which rates are adjusted to make them comparable. For example, age-standardised rates adjust for differing age structures in populations.
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