Spatial inequalities in behavioural and cardiometabolic health risk factors among Australian adults

Background Health risk factors are unevenly distributed across space, yet evidence comparing multiple behavioural and cardiometabolic risks across remoteness categories within a consistent analytical framework remains limited in Australia. Methods Using nationally representative data from the Australian Bureau of Statistics National Health Survey 2022, a cross-sectional household survey with ABS person-level weights, this study examined spatial variation in five health risk factors among adults aged 18 years and over: current daily smoking, physical inactivity, high blood pressure, obesity, and overweight or obesity. Prevalence estimates were compared across major cities, inner regional areas, and outer regional and remote areas. Spatial inequalities were assessed using descriptive statistics, absolute differences, prevalence ratios, and rank-order comparisons. Results Across all outcomes, prevalence was lowest in major cities and higher in non-metropolitan areas, although patterns varied by risk factor. Smoking prevalence was higher in outer regional and remote areas (16.7%) than in major cities (9.4%). Overweight or obesity and obesity also displayed marked disparities. Physical inactivity was highly prevalent across all areas, with particularly large gaps observed for extreme inactivity measures. For obesity and high blood pressure, the highest prevalence was observed in inner regional areas. Conclusions Spatial health inequalities in Australia are widespread but heterogeneous, underscoring the importance of risk-factor-specific and place-sensitive public health responses.