Socio-spatial inequalities in alcohol outlet availability: Evidence from register data in 15 urban areas in Québec,...

Alcohol spatial availability is linked with public health issues, with disadvantaged populations experiencing disproportionate harm. This study examined the association between alcohol spatial availability and area-level measures of disadvantage and sociodemographic characteristics in Québec, Canada.

We conducted a cross-sectional analysis using 2021 liquor register and census data across 15 Québec urban areas. Measures included outlet counts within 800 m buffers and a spatial access index. Multilevel regression models assessed associations with composite measures of area-level disadvantage and single-item measures of area-level sociodemographic characteristics.

On average, Québec areas exhibited higher offsite than onsite alcohol outlet availability. We found a J-shaped relationship between offsite alcohol availability and material disadvantage, with the most disadvantaged areas having 25 % more offsite outlets (95 % CI: 1.14-1.37) than the least disadvantaged. Conversely, onsite availability was 24 % lower (95 % CI: 0.67-0.87) in the most materially disadvantaged areas. Social disadvantage was associated with higher availability of both offsite and onsite outlets, with the highest socially disadvantaged areas having nearly 15 times as many onsite outlets (IRR 14.77, 95 % CI: 13.05-16.72) compared to the least disadvantaged. Higher population density and higher percentages of young adults, new immigrants, and recent movers were also associated with higher availability.

Alcohol availability differed by outlet type and disadvantage dimension. Offsite outlets were more common in both highly and minimally materially disadvantaged areas, while onsite outlets were more common in minimally disadvantaged areas. Socially disadvantaged areas had higher availability of both types of outlets. These findings suggest the need for targeted policies to reduce alcohol outlet availability, particularly in socially disadvantaged areas.