Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017

Abstract

Objective: While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. Methods: We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. Results: There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). Conclusion: Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural–urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.

Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study

“…This finding suggests that they had lower socio-economic status. This is consistent with other similar populations [ 5 , 22 ]. Low income was not a deterrent to a drinking lifestyle for the study population.…”

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

“…This understanding is currently missing in Canada. While multiple studies have shown a rural-urban disparity in alcohol use and alcoholrelated harm, 4,6,7 and others have used spatial data to assess the regional impact of certain alcohol policies, 8,9 no research has specifically characterized the geographic distribution of alcohol-related harms across urban, rural, and remote communities. In turn, it is unclear whether all rural communities are equally burdened by high rates of alcohol-related harm or whether certain regions require prioritization.…”

Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care

“…Rural Canadians were more likely to visit the emergency department due to alcohol than urban Canadians (56.0 vs. 44.8 per 10,000 individuals) [ 34 •]. When stratified by gender and age, rates of alcohol-related emergency department visits were highest among young men aged 15 to 24 years [ 34 •].…”

“…Rural Canadians were more likely to visit the emergency department due to alcohol than urban Canadians (56.0 vs. 44.8 per 10,000 individuals) [ 34 •]. When stratified by gender and age, rates of alcohol-related emergency department visits were highest among young men aged 15 to 24 years [ 34 •]. Though not directly assessed, the utilization of emergency department services may indicate rural individuals are not being captured at less intensive levels of care.…”