Rural-urban disparities in post-discharge outcomes following alcohol-related hospitalizations in Ontario, Canada: A retrospective cohort study. (1st September 2022)

• Record Type: Journal Article
• Authors: Friesen, Erik Loewen; Myran, Daniel; Yu, Winnie; Rosella, Laura; Selby, Peter; Kurdyak, Paul
• Is Part Of: Drug and alcohol dependence. Volume 238(2022)
• Publication Date: 2022-09-01
• Subjects: Alcohol use -- Rural health -- Alcohol-related hospitalization -- Mental health -- Health services -- Alcohol use disorder; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109568
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: Limited access to mental health and addiction (MHA) services in rural areas may increase the risk of recurrent alcohol-related harm among rural, relative to urban, residents. This study evaluated (1) rural-urban differences in clinical trajectories following alcohol-related hospitalizations and (2) whether limited access to MHA services mediates an increased risk of adverse post-discharge outcomes in rural areas. Methods: This was a population-based retrospective cohort study of individuals in Ontario, Canada, who experienced an alcohol-related hospitalization between 2016 and 2018. The primary exposure was rurality. The outcomes of interest were outpatient MHA care, alcohol-related emergency department visits, alcohol-related hospitalizations, and all-cause mortality within one-year of discharge from the index alcohol-related hospitalization. Data were collected using provincial health administrative databases. The associations between rurality and the time to each outcome were assessed using multivariable time-to-event regression. Mediation analyses were conducted using a counterfactual approach. Results: 46, 657 individuals were included. 11.5% of the cohort died within one year of discharge from the index alcohol-related hospitalization. Relative to urban residents, rural residents were less likely to receive MHA outpatient care (adjusted hazard ratio (aHR): 0.80, 95% confidence interval (CI): 0.75–0.86) and more likely to die (aHR: 1.19, 95% CI: 1.06–1.34) in the year following discharge. The lower likelihood of post-discharge MHA-related care among rural residents mediated 31% (95% CI: 13–46%) of the increased risk of mortality. Conclusions: A lack of follow-up MHA care mediates an increased risk of short-term mortality following alcohol-related hospitalizations in rural, relative to urban, communities. Highlights: 1 in 10 individuals who were hospitalized for an alcohol-related health condition died within one year of discharge. Individuals living in urban-adjacent rural, relative to urban, areas were at a higher risk of post-discharge mortality. Reduced access to mental health and addiction services partially mediated the increased risk of death among rural patients.