Inequity in the availability and quality of health care may exist across geographical locations. Little is known about whether living in remote areas is associated with worse health outcomes in Australians with multiple sclerosis (MS), which is important information for health care planning.
We aimed to evaluate whether living in regional or remote areas was associated with worse disease outcomes, employment outcomes, health-related quality of life (HRQoL), disease modifying therapy (DMT) utilisation and cost of illness among Australians with MS.
Around 3000 participants of the Australian MS Longitudinal Study were invited to participate in three surveys in 2016. Level of remoteness (major cities, inner regional, outer regional, remote and very remoted Australia) was determined using postcode. Information on MS type, DMT use, HRQoL, severity of 13 MS symptoms, disability and employment outcomes were collected. Data were analysed using linear regression, log-binomial regression, log-multinomial regression and negative binomial regression.
Living in more remote areas was not associated with substantially worse health/employment outcomes, or higher MS costs among Australians with MS. There was a consistent pattern of those living in inner regional areas having slightly worse health outcomes and higher costs, but the effect sizes were relatively small and there were no clear dose-response relationships with increasing remoteness. They were also less likely to use high efficacy DMTs compared to those living in major cities. Adjusting for factors such as age, disease duration, and education level only marginally reduced the associations.
There is no large inequity in outcomes within the Australian MS population as a result of remoteness, although those living in inner regional areas had slightly worse health outcomes and higher MS costs.