Increase in alcohol outlets by neighbourhood socioeconomic status following the expansion of alcohol sales into convenience stores in Ontario, Canada.

Introduction: In September 2024, the province of Ontario expanded alcohol sales into convenience stores. It is important to examine differences in alcohol sales expansion by socioeconomic status (SES) as lower SES groups experience a disproportionately higher burden of alcohol-attributable harms.

Methods: This repeated cross-sectional study examined whether neighbourhood SES was associated with increases in alcohol outlets immediately following the expansion of alcohol sales. A spatial BYM2 Poisson regression model was used to estimate the association between neighbourhood SES and the number of alcohol outlets.

Results: Immediately following expansion, 4200 alcohol outlets were licensed in Ontario. The median increase in alcohol outlets within 1500 m of a neighbourhood was greater in the lowest SES neighbourhoods (400% increase) compared to the highest (183%). In adjusted models, the lowest SES quintile was associated with a greater increase in outlets (relative risk = 2.26, 95% credible interval:1.98-2.58) compared to the highest quintile, with a dose-response relationship by SES quintile.

Discussion: A large increase in alcohol outlets was seen across Ontario neighbourhoods. Lower SES neighbourhoods experienced a greater increase in outlets, which may disproportionately increase harms related to the expansion of alcohol sales. These findings highlight the need for strategies to mitigate potential harm in low SES groups and the widening of existing inequities.