Understanding Rural-urban Disparities in Alcohol-related Health Service Use in Ontario, Canada
Bibliographic record
Abstract
Introduction: Rural, relative to urban, communities in Ontario, Canada experience disproportionately high rates of alcohol-related emergency department (ED) visits and hospitalizations; however, we have a limited understanding of why this disparity exists. The purpose of this thesis was to better understand rural-urban disparities in alcohol-related health service use to inform the development of evidence-based public health strategies that address high rates of alcohol-related harm in rural Ontario. Methods: This thesis was composed of three separate but related projects. The first was a scoping review of the international literature on rural-urban disparities in hazardous alcohol use and alcohol-related harm. The second was a geospatial analysis of regional rates of alcohol-related ED visits and hospitalizations across rural and urban Ontario health regions. The third was a retrospective cohort study evaluating rural-urban differences in clinical outcomes following alcohol-related hospitalizations. The latter two projects made use of Ontario health administrative data. Results: All three projects demonstrated that increasing rurality is associated with higher rates of alcohol-related harm. The retrospective cohort study also indicated that limited access to mental health and addiction services partially mediates the increased risk of alcohol-related harm in rural Ontario. Despite this general trend, each study also revealed important complexities to this association that merit consideration in future policy development. For example, the scoping review found that rural-urban disparities in alcohol-related harm vary based on the type of harm being evaluated and the sociodemographic characteristics of the study population. The spatial analysis found that the association between rurality and alcohol-related health service use differed between Northern and Southern Ontario. Finally, the retrospective cohort study indicated that the associations between rurality and clinical outcomes following alcohol-related hospitalizations are non-linear and vary substantially between outcome types. Conclusions: The results of thesis corroborate previous evidence that rural, relative to urban, communities in Ontario experience higher rates of alcohol-related harm but indicate that this association is not simple or linear. Rural communities should be prioritized for public health interventions aimed at reducing alcohol-related harm; however, more research is required to understand how these policies can be tailored to meet regional needs in an evidence-based manner.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.009 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".