Investigation of rural–urban differences in hospitalization for ambulatory care-sensitive conditions: Analysis of linked survey, hospitalization, and tax data from Canada

Abstract

Background

Hospitalizations for ambulatory care sensitive conditions (ACSCs) reflect the efficiency of the primary care system, as these are preventable with timely and effective management of chronic conditions. We examined ACSC hospitalization trends in Canada's rural and urban areas, excluding Quebec, from 2007 to 2019.

Methods

The data came from Canadian Community Health Surveys linked with hospitalizations and household income tax records. The study focused on adults aged 18–74 years and used logit and zero-inflated Poisson models to analyze ACSC hospitalizations and costs. A non-linear decomposition method quantified explained and unexplained rural–urban gaps in ACSC hospitalizations and costs.

Results

We found persistent disparities in ACSC hospitalizations between rural and urban areas, although the gap has narrowed since 2010. Even after adjusting for socio-demographic factors, chronic conditions, and risky health behaviors, rural–urban disparities in ACSC rates remained, highlighting unequal access to primary care in rural areas. The decomposition results revealed that the disparities were driven mainly by differences in the observed characteristics. Further investigation revealed that disparities were due to populations with lower income and education, and residents in Atlantic provinces.

Conclusions

This study underscores the importance of a strong primary care system to minimize ACSC-related hospitalizations in rural Canada. Our results highlight the benefits of primary care reforms undertaken by provinces over the past decade in reducing rural–urban gaps in ACSC hospitalizations. Future policy interventions targeting disadvantaged populations, such as those with lower income and education, are vital for reducing avoidable hospitalizations and enhancing population health outcomes in rural areas.