Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada

Abstract

Background Knowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada. Methods Five administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran’s I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots). Results Among 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran’s I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192–195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168–171) compared to Rural areas (Fox Creek: 65, 95%CI 63–68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots. Conclusions The findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.

Rural–Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors

“…Furthermore, the size of 132 LGAs varies greatly across the province. The average size of 31 metro LGAs in Calgary and Edmonton is 50 km 2 compared to the average size of 26,742 km 2 in the 12 rural remote LGAs in the north zone [ 3 ]. As urban areas have a larger number of PCP options available within a highly populated, smaller geographic area, urban patients usually have reasonable access to PCPs across many LGAs.…”

“…However, the advantage of using LGA, an administrative geographic unit, as the area unit for analysis is that it aligns with the planning purposes of AHS, which uses LGA to monitor, plan, and evaluate the delivery of health services in Alberta. The sizes of LGAs vary greatly across rural and urban areas, ranging from 7 km 2 in the metro areas to 99,994 km 2 in the rural remote areas [ 3 ]. This may bring in bias when measuring travel time and cross-boundary travel patterns.…”

“…Rural–urban disparities in the prevalence of osteoarthritis (OA) have been reported at national and provincial levels in Canada, demonstrating significantly higher rates of OA in rural and remote areas compared to urban areas [ 1 , 2 , 3 ]. The population health burden of OA is expected to increase and reach one in four Canadians by 2040 [ 4 , 5 ] due to an aging population and rising rates of obesity [ 6 , 7 ].…”

Geography as a Determinant of Health: Health Services Utilization of Pediatric Respiratory Illness in a Canadian Province

“…Health inequalities are common in rural and northern regions of Alberta, particularly in terms of adequate access to preventive and primary healthcare [50,58]. Rural communities with greater distances to large urban centers often have lower vaccination rates than their metropolitan counterparts [59,60].…”

“…Given that both influenza and several upper and lower respiratory tract infections in children are preventable through vaccinations, this may result in higher rates in ED visits and hospitalizations in these regions. Several studies have also shown that rural and northern communities face barriers to accessing primary care [58,63,64]. They often require ED visits as their only means of obtaining healthcare services or may require these services due to the progressive severity of their conditions [65].…”