Associations between walkability and pedestrian related injuries is modified by sociodemographic characteristics.

BACKGROUND: Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney. METHOD: Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity. RESULT: Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years. CONCLUSION: For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Exploring the Use of Hospital and Community Mental Health Services Among Newly Resettled Refugees.

Importance: Resettled refugees in high-income countries represent a vulnerable population. It is known that refugees have high rates of trauma-related mental health issues; however, ad hoc research has generally revealed low rates of health services use among refugees. Such research usually samples a population at a single point in time and is based on targeted surveys. Because refugee populations change over time, such research becomes expensive and time-consuming for agencies interested in routinely publishing statistics of mental health services use among refugees. The linking of large administrative data sets to establish rates of use of mental health services among resettled refugees is a flexible and relatively inexpensive approach. Objective: To use data linkage to establish rates of mental health services use among resettled refugees relative to the general population. Design, Setting, and Participants: This cross-sectional study implemented data linkage from the Refugee Health Nurse Program for 10 050 refugees who resettled in Sydney, Australia, from October 23, 2012, to June 8, 2017, with data concerning use of community mental health services and mental health hospitalization from New South Wales Health databases. Data were analyzed between June 1, 2019, and December 31, 2021. Main Outcomes and Measures: Rates of service contacts with community mental health services among the resettled refugees were compared with those of the general population by age, sex, and the most common International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes. Length of community mental health service sessions and rates of mental health hospitalizations were also compared. Results: Among the 255 resettled refugees who had contacts with community mental health care services and were not missing data (median age, 35 [range, 4-80] years; 117 [64%] male and 138 [54%] female), 153 (60%) were born in Iraq and 156 (61%) were Arabic speaking. This population was less likely to use mental health services than the general population and had shorter community mental health consultations. The rate of contacts with community mental health services for depressive disorders among the resettled refugee population was 40% (95% CI, 33%-46%) lower than that among the general population. Rates of same-day hospitalization per 10 000 person-years were not significantly different between the refugee population (4 [95% CI, 2-8]) and the general Australian population (7 [95% CI, 7-7]). However, the refugee population was 17% (95% CI, 6%-29%) more likely than the general Australian population to interact with the community mental health system for severe stress- and adjustment disorder-related diagnoses. Conclusions and Relevance: These findings suggest that refugees who have resettled in Australia tend to use fewer mental health services than the general population except for services devoted to stress- and adjustment disorder-related diagnoses. These findings also suggest that it is possible to successfully leverage data linkage to study patterns of mental health services use among resettled refugees.

Associations Between Ambient Particulate Air Pollution and Cognitive Function in Indonesian Children Living in Forest Fire-Prone Provinces.

Smoke from forest fires can reach hazardous levels for extended periods of time. We aimed to determine if there is an association between particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) and living in a forest fire-prone province and cognitive function. We used data from the Indonesian Family and Life Survey. Cognitive function was assessed by the Ravens Colored Progressive Matrices (RCPM). We used regression models to estimate associations between PM2.5 and living in a forest fire-prone province and cognitive function. In multivariable models, we found very small positive relationships between PM2.5 levels and RCPM scores (PM2.5 level at year of survey: ß = 0.1%; 95% confidence interval (CI) [0.01, 0.19%]). There were no differences in RCPM scores for children living in forest fire-prone provinces compared with children living in non-forest fire-prone provinces (mean difference = -1.16%, 95% CI [-2.53, 0.21]). RCPM scores were lower for children who had lived in a forest fire-prone province all their lives compared with children who lived in a non-forest fire-prone province all their life (ß = -1.50%; 95% CI [-2.94, -0.07]). Living in a forest fire-prone province for a prolonged period of time negatively affected cognitive scores after adjusting for individual factors.

Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia.

INTRODUCTION: Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. METHODS: In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as 'healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. RESULTS: Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. CONCLUSION: Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes.

Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes?

The choice of a green space metric may affect what relationship is found with health outcomes. In this research, we investigated the relationship between percent green space area, a novel metric developed by us (based on the average contiguous green space area a spatial buffer has contact with), in three different types of buffers and type 2 diabetes (T2D). We obtained information about diagnosed T2D and relevant covariates at the individual level from the large and representative 45 and Up Study. Average contiguous green space and the percentage of green space within 500 m, 1 km, and 2 km of circular buffer, line-based road network (LBRN) buffers, and polygon-based road network (PBRN) buffers around participants' residences were used as proxies for geographic access to green space. Generalized estimating equation regression models were used to determine associations between access to green space and T2D status of individuals. It was found that 30%-40% green space within 500 m LBRN or PBRN buffers, and 2 km PBRN buffers, but not within circular buffers, significantly reduced the risk of T2D. The novel average green space area metric did not appear to be particularly effective at measuring reductions in T2D. This study complements an existing research body on optimal buffers for green space measurement.

Walkability and Greenness Do Not Walk Together: Investigating Associations between Greenness and Walkability in a Large Metropolitan City Context.

BACKGROUND: The existing environment literature separately emphasizes the importance of neighborhood walkability and greenness in enhancing health and wellbeing. Thus, a desirable neighborhood should ideally be green and walkable at the same time. Yet, limited research exists on the prevalence of such "sweet spot" neighborhoods. We sought to investigate this question in the context of a large metropolitan city (i.e., Sydney) in Australia. METHODS: Using suburb level normalized difference vegetative index (NDVI), percentage urban greenspace, Walk Score® (Walk Score, Seattle, WA, USA), and other data, we explored the global and local relationships of neighborhood-level greenness, urban green space (percent park area) with walkability applying both non-spatial and spatial modeling. RESULTS: We found an overall negative relationship between walkability and greenness (measured as NDVI). Most neighborhoods (represented by suburbs) in Sydney are either walkable or green, but not both. Sweet spot neighborhoods that did exist were green but only somewhat walkable. In addition, many neighborhoods were both less green and somewhat walkable. Moreover, we observed a significant positive relationship between percentage park area and walkability. These results indicate walkability and greenness have inverse and, at best, mixed associations in the Sydney metropolitan area. CONCLUSIONS: Our analysis indicates an overall negative relationship between greenness and walkability, with significant local variability. With ongoing efforts towards greening Sydney and improving walkability, more neighborhoods may eventually be transformed into becoming greener and more walkable.

Identifying community chronic kidney disease risk profile utilising general practice clinical records and spatial analysis: approach to inform policy and practice.

BACKGROUND: Chronic kidney disease (CKD) causes a significant health burden in Australia, and up to 50% of Australians with CKD remain undiagnosed. AIMS: To estimate the 5-year risk for CKD from general practice (GP) clinical records and to investigate the spatial variation and hot spots of CKD risk in an Australian community. METHOD: A cross-sectional study was designed using de-identified GP clinical data recorded from 2010 to 2015. A total of 16 GP participated in this study from West Adelaide, Australia. We used health records of 36 565 patients aged 35-74 years, with no prior history of CKD. The 5-year estimated CKD risk was calculated using the QKidney algorithm. Individuals' risk score was aggregated to Statistical Area Level 1 to predict the community CKD risk. A spatial hotspot analysis was applied to identify the communities with greater risk. RESULTS: The mean estimated 5-year risk for CKD in the sample population was 0.95% (0.93-0.97). Overall, 2.4% of the study population was at high risk of CKD. Significant hot spots and cold spots of CKD risk were identified within the study region. Hot spots were associated with lower socioeconomic status. CONCLUSIONS: This study demonstrated a new approach to explore the spatial variation of CKD risk at a community level, and implementation of a risk prediction model into a clinical setting may aid in early detection and increase disease awareness in regions of unmet CKD care.

Giardiasis notifications are associated with socioeconomic status in Sydney, Australia: a spatial analysis.

OBJECTIVE: In developed countries prolonged symptoms due to, or following, Giardia intestinalis infection can have a significant impact on the quality of life. In this research, we investigate the presence of a socioeconomic status (SES) gradient in the reporting of giardiasis in South West Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia, across geographic scales. METHODS: We used a large database, spatial-cluster analysis and a linear model. RESULTS: Firstly, we found one spatial cluster of giardiasis in one of the most advantaged neighbourhoods of SWSLHD. Secondly, rates of giardiasis notifications were significantly and consistently lower in SWSLHD compared to an unnamed advantaged Local Health District and NSW over multiple years. Finally, we found an overall significant positive dose-response relationship between counts of giardiasis and area-level SES. CONCLUSIONS: Lower reporting in disadvantaged areas may represent true differences in incidence across SES groups or may result from differential use of health services and reporting. Implications for public health: If the disparities result from differential use of health services, research should be directed toward identifying barriers and facilitators of use. If disparities result from a true difference in incidence, then the behavioural mediators between SES and giardiasis should be identified and addressed.

Tree Canopy Cover Is Best Associated with Perceptions of Greenspace: A Short Communication.

A growing literature has supported a relationship between greenspace and health. Various greenspace metrics exist; some are based on subjective measures while others are based on an objective assessment of the landscape. While subjective measures may better reflect individual feelings about surrounding greenspace and the resulting positive benefits thereof, they are expensive and difficult to collect. In contrast, objective measures can be derived with relative ease, in a timely fashion, and for large regions and populations. While there have been some attempts to compare objective and subjective measures of greenspace, what is lacking is a comprehensive assessment of a wide range of greenspace metrics against subjective measures of greenspace. We performed such an assessment using a set of three objective greenspace metrics and a survey of residents in Liverpool, New South Wales, Australia. Our study supported existing findings in that overall, there is very little agreement between perceived and objective greenspace metrics. We also found that tree canopy in 10 min walking buffers around residences was the objective greenspace measure in best agreement with perceived greenspace.

Spatial clusters of chronic preventable hospitalizations (ambulatory care sensitive conditions) and access to primary care.

BACKGROUND: Potentially preventable hospitalizations (PPHs) or ambulatory care sensitive conditions (ACSCs) represent hospitalizations that could be successfully managed in a primary care setting. Research from the USA and elsewhere on the role of primary care provider (PCP) access as a PPH driver has been conflicting. We investigated the role of PCP access in the creation of areas with persistently significant high rates of PPHs over time or PPH hotspots/spatial clusters. METHODS: Using a detailed dataset of PCPs and a dataset of 106 334 chronic PPH hospitalizations from South Western Sydney, Australia, we identified hotspots of chronic PPHs. We contrasted how hotspot PPHs were different from other PPHs on a range of factors including PCP access. RESULTS AND CONCLUSIONS: Six spatially contiguous areas comprising of eight postcodes were identified as hotspots with risks ranging from 1.6 to 2.9. The hotspots were found to be more disadvantaged and had better PCP access than other areas. Socioeconomic disadvantage explained the most variation (8%) in clustering while PCP access explained only a small fraction though using detailed PCP access measures helped. Nevertheless a large proportion of the variation remained unexplained (86.5%) underscoring the importance of individual level behaviours and other factors in driving chronic PPH clustering.

Identifying hotspots of type 2 diabetes risk using general practice data and geospatial analysis: an approach to inform policy and practice.

The prevalence of type 2 diabetes (T2D) is increasing worldwide and there is a need to identify communities with a high-risk profile and to develop appropriate primary care interventions. This study aimed to predict future T2D risk and identify community-level geographic variations using general practices data. The Australian T2D risk assessment (AUSDRISK) tool was used to calculate the individual T2D risk scores using 55693 clinical records from 16 general practices in west Adelaide, South Australia, Australia. Spatial clusters and potential 'hotspots' of T2D risk were examined using Local Moran's I and the Getis-Ord Gi* techniques. Further, the correlation between T2D risk and the socioeconomic status of communities were mapped. Individual risk scores were categorised into three groups: low risk (34.0% of participants), moderate risk (35.2% of participants) and high risk (30.8% of participants). Spatial analysis showed heterogeneity in T2D risk across communities, with significant clusters in the central part of the study area. These study results suggest that routinely collected data from general practices offer a rich source of data that may be a useful and efficient approach for identifying T2D hotspots across communities. Mapping aggregated T2D risk offers a novel approach to identifying areas of unmet need.

Neighbourhood greenspace and physical activity and sedentary behaviour among older adults with a recent diagnosis of type 2 diabetes: a prospective analysis.

OBJECTIVES: Greenspace is one of the important factors that can promote an active lifestyle. Thus, greener surroundings may be a motivating factor for people with newly diagnosed diabetes to engage in more physical activity. Given that diagnosis of type 2 diabetes (T2D) may serve as a window opportunity for behavioural modification, we hypothesise that the association between neighbourhood greenspace and physical activity among people with newly diagnosed T2D may be greater than those not diagnosed with T2D. The aim of this study was to investigate the association between access to greenspace and changes in physical activity and sedentary behaviour, and whether these associations differed by T2D. DESIGN: Prospective cohort. SETTING: New South Wales, Australia. METHODS: We used self-reported information from the New South Wales 45 and Up Study (baseline) and a follow-up study. Information on sitting, walking and moderate to vigorous physical activity was used as outcomes. The proportion of greenspace within 500 m, 1 km and 2 km road network buffers around participant's residential address was generated as a proxy measure for access to greenspace. The association between the access to greenspace and the outcomes were explored among the newly diagnosed T2D group and those without T2D. RESULTS: Among New T2D, although no significant changes were found in the amount of walking with the percentage of greenspace, increasing trends were apparent. There was no significant association between the percentage of greenspace and changes in amount of moderate to vigorous physical activity (MVPA). Among No T2D, there were no significant associations between the amount of MVPA and walking, and percentage of greenspace. For changes in sitting time, there were no significant associations with percentage of greenspace regardless of buffer size. CONCLUSIONS: In this study, there was no association between access to greenspace at baseline and change in walking, MVPA and sitting time, regardless of T2D status.

A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation.

BACKGROUND: Detecting the variation of health indicators across similar areas or peer geographies is often useful if the spatial units are socially and economically meaningful, so that there is a degree of homogeneity in each unit. Indices are frequently constructed to generate summaries of socioeconomic status or other measures in geographic small areas. Larger areas may be built to be homogenous using regionalization algorithms. However, there are no explicit guidelines in the literature for the grouping of peer geographies based on measures such as area level socioeconomic indices. Moreover, the use of an index score becomes less meaningful as the size of an area increases. This paper introduces an easy to use statistical framework for the identification and classification of homogeneous areas. We propose the Homogeneity and Location indices to measure the concentration and central value respectively of an areas' socioeconomic distribution. We also provide a transparent set of criteria that a researcher can follow to establish whether a set of proposed geographies are acceptably homogeneous or need further refining. RESULTS: We applied our framework to assess the socioeconomic homogeneity of the commonly used SA3 Australian census geography. These results showed that almost 60% of the SA3 census units are likely to be socioeconomically heterogeneous and hence inappropriate for presenting area level socioeconomic disadvantage. We also showed that the Location Index is a more robust descriptive measure of the distribution compared to other measures of central tendency. Finally, the methodology proposed was used to analyse the age-standardized variation of GP attenders in a metropolitan area. The results suggest that very high GP attenders (20+ visits) live in SA3s with the most socioeconomic disadvantage. The findings revealed that households with low income and families with children and jobless parents are the major drivers for discerning disadvantaged communities. CONCLUSION: Reporting indicators rates for geographies grouped according to similarity may be useful for the analysis of geographic variation. The use of a framework for the identification of meaningful peer geographies would be beneficial to health planners and policy makers by providing realistic and valid peer group geographies.

Prescription opioid dispensing in New South Wales, Australia: spatial and temporal variation.

BACKGROUND: Patterns of opioid dispensing often exhibit substantial temporal and geographical variability, which has implications for public health policy decisions and interventions. The study examined recent trends in prescription opioid dispensing and identified high dispensing areas and factors associated with the doses dispensed. METHODS: Three years (1 January 2013-31 December 2015) of dispensing data of prescription opioids in local government areas (LGAs) for New South Wales (NSW), Australia's most populous state, were analyzed. The proportion of individuals who were dispensed opioids was computed for four age-groups. A Chi-square test was used to examine trends over time in proportions of the population who were dispensed opioids in four age-groups. The number of prescriptions over time and quantities in daily defined dose/1000 people/day (denoted DDD) were also examined. LGAs with relatively high levels of dispensing were identified and mapped. A multivariate regression model was used to identify factors associated with DDD. RESULTS: Overall, codeine, oxycodone and tramadol were the main opioids in terms of DDD, number of prescriptions and number of individuals who were dispensed these medications. Quantity (in DDD), and population dispensed to were consistently higher for women than men over time. Proportions of individuals who were dispensed opioids increased significantly over time in all four age-groups. In the multivariate model, age, urbanization, sex and socio-economic indexes for areas were significantly associated with doses dispensed among opioid users. All areas with very high dispensing were outside major metropolitan areas. CONCLUSIONS: Given that over-use of opioids is a major public health problem and that long-term use has substantial side effects including dependence, it is important to understand spatial patterns of opioid prescribing to enable targeted interventions. Nationwide implementation of real-time drug-monitoring programs and access to monitoring databases from both doctor and pharmacy point-of-care sources may potentially reduce excessive and undue use of opioid.

Effects of Distant Green Space on Physical Activity in Sydney, Australia.

BACKGROUND: The aim was to investigate the association between distant green space and physical activity modified by local green space. METHODS: Information about physical activity, demographic and socioeconomic background at the individual level was extracted from the New South Wales Population Health Survey. The proportion of a postcode that was parkland was used as a proxy measure for access to parklands and was calculated for each individual. RESULTS: There was a significant relationship between distant green space and engaging in moderate-to-vigorous physical activity (MVPA) at least once a week. No significant relationship was found between adequate physical activity and distant green space. No significant relationships were found between adequate physical activity, engaging in MVPA, and local green space. However, if respondents lived in greater local green space (≥25%), there was a significant relationship between engaging in MVPA at least once a week and distance green space of ≥20%. CONCLUSION: This study highlights the important effect of distant green space on physical activity. Our findings also suggest that moderate size of local green space together with moderate size of distant green space are important levers for participation of physical activity.

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state.

OBJECTIVES: To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. DESIGN: A cross-sectional analysis of public hospital episode data (2007-2013). SETTING: Hospitalisations from the ACT, Australia at very small geographic areas. PARTICIPANTS: Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. MAIN EXPOSURE MEASURES: Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. MAIN OUTCOME MEASURES: Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. RESULTS: Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers. CONCLUSIONS: Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.

How Can Geographical Information Systems and Spatial Analysis Inform a Response to Prescription Opioid Misuse? A Discussion in the Context of Existing Literature.

The misuse of prescription opioids is a major public health problem in the United States, Canada, Australia and other parts of the developed world. Methods to quantify dimensions of the risk environment in relation to drug usage and law enforcement that are both structural and spatial, draw geography into traditional public health research even though there has been limited attempt to address the prescription opioid misuse problem from a geographic perspective. We discuss how geographic technologies can be utilized to study the landscape of prescription opioids and similar drugs, and target appropriate health services interventions. We use examples drawn from various jurisdictions to present our case and highlight through these examples how a geospatial perspective can help support research on prescription opioid misuse. The prescription drug misuse landscape can be studied through examination of the domains of demand, supply, harms and harm reduction. We discuss how each of these domains can benefit from a local geographic perspective, and subsequent geographic exploration and analyses.

Doctors on the move: National estimates of geographical mobility among general practitioners in Australia.

BACKGROUND: The aim of this study was to examine the geographical mobility patterns on a national level of general practitioners (GPs) across degrees of rurality. While this is a topic with great policy implications, negligible published research exists in Australia on this topic. METHODS: Publicly available data for all registered GPs with specialist 'general practice' registration for 2011 and 2013 were obtained from the Australian Health Professional Registration Agency (AHPRA) and analysed. RESULTS: Annually, about 10% of Australian GPs have changed their principal place of practice (PPP), and about 1% of GPs moved between states. A net move into major cities was observed. Major cities were the most favoured destination of GPs moving out of a remote area, and the largest source of GPs moving into remote and very remote areas. Among GPs, there was a gradient of increasing distances moved with increasing rurality. DISCUSSION: This study shows for the first time that annually, about 10% of GPs change their PPP over a short time period. The drift of GPs away from rural areas indicates that policymakers should focus on recruitment and retention in these areas, preferably providing incentives for moving specifically from metropolitan areas.