Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
J Rural Health. 2023 Jan;39(1):223-232. doi: 10.1111/jrh.12702. Epub 2022 Jul 22.
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.
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.
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).
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.
在加拿大，农村地区的酒精相关伤害发生率高于城市地区。本研究旨在描述安大略省酒精相关急诊（ED）就诊和住院的空间分布和区域决定因素，以更好地理解这种农村与城市之间的差异。
这是一项对加拿大安大略省卫生部分区（n=76）2016 年至 2019 年期间酒精相关 ED 就诊和住院率的横断面空间分析。使用空间自相关方法确定与酒精相关伤害的热点和冷点区域。农村性通过分区人口加权地理偏远程度来衡量。使用分层贝叶斯空间回归模型评估农村性与酒精相关 ED 就诊和住院率之间的关系。
各分区之间的酒精相关 ED 就诊和住院率差异很大，高发生率聚集在安大略省北部。总体而言，农村性的增加与酒精相关 ED 就诊率的地区水平升高有关（男性调整后相对比率[aRR]：1.67，95%可信区间[CI]：1.49-1.87；女性 aRR：1.78，95% CI：1.60-1.98）和住院率（男性 aRR：1.34，95% CI：1.24-1.45；女性 aRR：1.59，95% CI：1.45-1.74）。然而，在将该省分为北部和南部两个区后，这种相关性仅在北部地区成立。相比之下，农村性的增加与南部地区酒精相关 ED 就诊率的降低有关（男性 aRR：0.87，95% CI：0.79-0.96；女性 aRR：0.88，95% CI：0.81-0.97）。
农村性与酒精相关卫生服务使用之间的关系存在区域差异。在制定减少酒精相关伤害的地理差异的卫生政策时，应考虑这种区域差异。
