Cancer
The age-standardised incidence rate of all cancers combined was highest in Inner regional and Outer regional areas in 2012–2016 (513 and 512 per 100,000 people, respectively), slightly lower in Major cities and Remote areas (both 487 cases per 100,000 people), and lowest in Very remote areas (422 cases per 100,000 people) (AIHW 2021f).
However, the incidence rate for all cancer for Very remote areas may be influenced by lower population screening participation rates, later detection of a cancer and lower life expectancy due to death from other causes (AIHW 2022b; Fox and Boyce 2014). Very remote areas had the highest incidence rate for cervical cancer, liver cancer, cancer of unknown primary site, uterine cancer and head and neck cancers (including lip).
In the period 2012–2016, people living in Major cities had the highest 5-year observed survival for all cancers combined (63%) while Very remote areas had the lowest (55%) (AIHW 2021f).
See Cancer in Australia 2021and Cancer.
Burden of disease
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.
In 2018, after adjusting for age, the total burden of disease and injury in Australia increased with increasing remoteness. Major cities experienced the least burden per population, while Remote and very remote areas experienced the most. The rate of disease burden in Remote and very remote areas was 1.4 times as high as that for Major cities.
This pattern was mostly driven by fatal burden (years of life lost due to premature death). In Remote and very remote areas, fatal burden rates were 1.8 times as high as that of Major cities, while non-fatal burden rates – the rates of burden from living with ill health as measured by years lived with disability – were 1.1 times as high. Kidney and urinary diseases, injuries and infections were disease groups with noticeably higher rates of burden in Remote and very remote areas, compared with Major cities (more than twice as high) (AIHW 2021d).
See Australian Australian Burden of Disease Study and Burden of disease.
Deaths
People living in rural and remote areas are more likely to die at a younger age than their counterparts in Major cities. They have higher mortality rates and higher rates of potentially avoidable deaths than those living in Major cities.
In 2020, age-standardised mortality rates increased as remoteness increased for males and females:
- Males living in Very remote areas had a mortality rate 1.3 times as high as those living in Major cities.
- Females living in Very remote areas had a mortality rate 1.5 times as high as those living in Major cities.
Males had a higher mortality rate than females in all remoteness areas, with the highest difference in Remote areas –at 1.5 times higher (AIHW 2022b) (Table 1).
See Life expectancy and causes of death.
Table 1: Median age at death, mortality rate, and rate ratio, by sex and remoteness area, 2020
|
Major cities
|
Inner Regional
|
Outer Regional
|
Remote
|
Very remote
|
Median age at death (Males)
|
79.6
|
78.7
|
76.8
|
73.1
|
65.7
|
Age-standardised rate (deaths per 100,00) (Males)
|
545.9
|
630.7
|
668.1
|
703.3
|
712.7
|
Rate ratio (Males)
|
0.94
|
1.09
|
1.15
|
1.21
|
1.23
|
Median age at death (Females)
|
85.2
|
84.3
|
82.7
|
78.3
|
66.2
|
Age-standardised rate (deaths per 100,00) (Females)
|
388.6
|
435.9
|
461.0
|
468.7
|
569.5
|
Rate ratio (Females)
|
0.95
|
1.07
|
1.13
|
1.15
|
1.40
|
Source: AIHW 2022b
Leading causes of death 2016–2020
Figure 4 shows the 10 leading causes of death for each remoteness area for the period 2016–2020, with comparison to mortality to rates for Australia overall (AIHW 2022b).
- Coronary heart disease was the leading cause of death across all remoteness areas. Age-standardised rates were higher in Very remote (1.6 times) and Remote areas (1.3 times) than for Australia overall.
- The top 7 causes of death were the same for Major cities, Inner regional and Outer regional areas.
- Land transport accidents were a leading cause of death in Remote and Very remote areas. The rate of dying due to land transport accidents was nearly 3 times as high for Remote areas and nearly 4 times as high for Very remote areas, compared with Australia overall (AIHW 2022b).

Notes
- Rates are age-standardised to the 2001 Australian standard population.
- Leading causes of death are listed in order of number of deaths in each remoteness area from 2016–2020.
- Boxes are coloured based on rate ratio comparing each region to Australia overall.
Source AIHW 2022b; Table S4.
Potentially avoidable deaths
The rate of potentially avoidable deaths – deaths under the age of 75 from conditions that are potentially preventable through primary or hospital care, such as cancer screening and transport accidents – increased as remoteness increased. For more details on examples and definitions of potentially avoidable deaths see Potentially avoidable deaths.
In 2020, 17% of all deaths in Australia were potentially avoidable. For males and females, the rate increased with remoteness. After adjusting for age, the rates of potentially avoidable deaths were:
- 3.0 times as high for females in Very remote areas compared with females in Major cities (181 per 100,00 population compared with 61).
- 2.1 times as high for males in Very remote areas compared with males in Major cities (235 per 100,000 population compared with 111) (AIHW 2022b).
See Mortality Over Regions and Time (MORT) books.
Life expectancy
Estimates of life expectancy at birth represent the average number of years that a newborn baby can expect to live, assuming current age-specific death rates are experienced through their lifetime. In 2018–2020, life expectancy at birth was lower for those living outside of metropolitan areas (Table 2; ABS 2021b).
Table 2: Life expectancy by sex for Greater capital city and Rest of state 2018–2020
|
Males
|
Females
|
Persons
|
Greater Sydney
|
82.7
|
86.4
|
84.5
|
Rest of NSW
|
79.3
|
84.2
|
81.7
|
Greater Melbourne
|
82.6
|
86.3
|
84.4
|
Rest of Vic.
|
79.4
|
84.3
|
81.8
|
Greater Brisbane
|
81.6
|
85.7
|
83.6
|
Rest of Qld
|
80.2
|
84.9
|
82.5
|
Greater Adelaide
|
81.4
|
85.6
|
83.4
|
Rest of SA
|
79.6
|
84.4
|
82.0
|
Greater Perth
|
82.3
|
86.4
|
84.3
|
Rest of WA
|
79.0
|
84.3
|
81.6
|
Greater Hobart
|
80.6
|
84.9
|
82.7
|
Rest of Tas.
|
79.4
|
83.9
|
81.6
|
Greater Darwin
|
80.2
|
84.8
|
82.5
|
Rest of NT
|
73.0
|
77.4
|
75.1
|
Source: ABS 2021b.
Access to health care
People living in rural and remote areas face barriers to accessing health care, due to challenges of geographic spread, low population density, limited infrastructure, and the higher costs of delivering rural and remote health care.
Primary health care
Medicare claims data from 2020–21 show that the number of non-hospital non-referred attendances per person, such as general practitioner (GP) visits, were lower in Remote and Very remote areas (4.7 and 3.4 per person respectively), than in Outer regional areas (6.1 per person), Inner regional areas and Major cities (6.8 per person for each area) (Department of Health 2022).
However, bulk-billing rates were highest in Very remote areas (91%) and Major cities (90%) and slightly lower but similar in regional areas (87% in both Inner regional and Outer regional areas) and lowest in Remote areas (86%) (Department of Health 2022).
People living in Remote and Very remote areas also have lower rates of bowel, breast and cervical cancer screening (AIHW 2021e, 2021g, 2021h).
See General practice, allied health and other primary care services and Indigenous Australians and the health system.
Health workforce
Australians living in Remote and Very remote areas experience health workforce shortages, despite having a greater need for medical services and practitioners with a broader scope of practice (AMA 2017). For most health professionals including specialists (all doctors other than GPs who require a referral from another doctor) dentists, pharmacists, and other allied health professionals, there is a marked decline in the rate of clinical full-time equivalent (FTE) practitioners per 100,000 population once outside Major cities with the notable exception of nurses and midwives. The FTE rate for nurses and midwives is higher in Remote and Very remote areas compared with Major cities, Inner regional and Outer regional (Department of Health 2020) (Figure 5; Table S5).
Although the FTE rate for GPs increases with increasing remoteness, care should be taken in interpreting the data, as work arrangements in these areas have the potential to be more complicated (NRHA 2017). For example, there may be poor differentiation between general practice for on-call hours, activity for procedures and hospital work for GPs working in rural and remote areas, which affects the accuracy of statistics on GP supply and distribution (Walters et al. 2017).
See Health workforce.