Clarifying rural‐urban disparities in alcohol‐related emergency department visits and hospitalizations in Ontario, Canada: A spatial analysis

Purpose Rates of alcohol‐related harm are higher in rural versus urban Canada. This study characterized the spatial distribution and regional determinants of alcohol‐related emergency department (ED) visits and hospitalizations in Ontario to better understand this rural‐urban disparity. Methods This was a cross‐sectional spatial analysis of rates of alcohol‐related ED visits and hospitalizations by Ministry of Health subregion (n = 76) in Ontario, Canada between 2016 and 2019. Regional hot‐ and cold‐spots of alcohol‐related harm were identified using spatial autocorrelation methods. Rurality was measured as the population weighted geographic remoteness of a subregion. The associations between rurality and rates of alcohol‐related ED visits and hospitalizations were evaluated using hierarchical Bayesian spatial regression models. Findings Rates of alcohol‐related ED visits and hospitalizations varied substantially between subregions, with high rates clustering in Northern Ontario. Overall, increasing rurality was associated with higher subregion‐level rates of alcohol‐related ED visits (males adjusted relative rate [aRR]: 1.67, 95% credible interval [CI]: 1.49‐1.87; females aRR: 1.78, 95% CI: 1.60‐1.98) and hospitalizations (males aRR: 1.34, 95% CI: 1.24‐1.45; females aRR: 1.59, 95% CI: 1.45‐1.74). However, after the province was separated into Northern and Southern strata, this association only held in Northern subregions. In contrast, increasing rurality was associated with lower rates of alcohol‐related ED visits in Southern subregions (males aRR: 0.87, 95% CI: 0.79‐0.96; females aRR: 0.88, 95% CI: 0.81‐0.97). Conclusions There are regional differences in the association between rurality and alcohol‐related health service use. This regional variation should be considered when developing health policies to minimize geographic disparities in alcohol‐related harm.