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A missing factor in the reporting of medical research outcomes: Geographic classification of participants

Issue: 43(4) November 2017. Original articles Pages 76 – 79

Stuart Wark
School of Rural Medicine, University of New England, Armidale, NSW, Australia;


Background: It is known that rurally-residing individuals are often at a significant health disadvantage when compared to urban peers. Improving the health of rural residents has been directly identified as a key priority across the world; however, as models of healthcare are primarily derived from evidence-based research, any failure by the researcher base to consider rural needs may result in a poor alignment of health services against actual need. This paper reviews how consistently participants’ geographic classification is identified and considered as a factor in research reported in a leading medical journal, The Lancet.
Method: Using a predetermined definition of rurality as being locations with a population below 100,000 people, 300 eligible articles were reviewed retrospectively from The Lancet’s 2015-2017 editions. The purpose was to establish if the methodology and findings of these 300 research papers actively considered the geographic classification of participants.
Results: In approximately 60% of the 300 reviewed studies it was not possible to accurately determine participants’ geographic classification. Only 2% of papers focused on rural participants in isolation, with 18% using solely urban residents. The remaining 20% of papers had both rural and urban participants.
Conclusion: This sample of The Lancet articles indicates minimal attention has been paid to participants’ geographic classification. This failure to consider the relevance of location as a factor in outcomes potentially limits the applicability of research findings to a significant proportion of the community, and raises concerns about using such evidence bases for determining national health frameworks and practice guidelines.

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