Spatial Disparities of Sexual and Gender-Based Violence Emergency Room Use in Canada: A Rural Perspective

Area of Science:

• Public Health
• Sociology
• Rural Health

Background:

• Sexual and gender-based violence (SGBV) is a significant public health issue, disproportionately affecting women in rural, remote, and northern Canadian communities.
• Accessing SGBV services is challenging in rural areas, with limited national data on hospital-based care for related injuries.

Purpose of the Study:

• To examine emergency room use (ERU) for SGBV across urban and rural Canada from 2015-2021, including the COVID-19 pandemic.
• To analyze SGBV-related ERU by subtype, remoteness, and sociodemographic factors, using an intersectional geographic framework.

Main Methods:

• Utilized the 2016 Canadian Community Health and Environment Cohort, hospital administrative records, and the Index of Remoteness.
• Conducted stratified analyses by SGBV subtype (physical, intimate partner violence (IPV), sexual violence), remoteness level, and sociodemographic characteristics.

Main Results:

• Rural residents showed 65% higher odds of SGBV-related ERU compared to urban counterparts, with rates increasing with remoteness.
• During COVID-19, ERU for sexual and physical violence increased, while IPV-related ERU decreased, suggesting disrupted help-seeking.
• Higher ERU in rural areas was observed among younger individuals, women, immigrants, economically marginalized groups, and those in rental/subsidized housing.

Conclusions:

• Geographic isolation, social inequities, and structural barriers significantly influence emergency service use for SGBV-related injuries in rural Canada.
• Findings highlight the urgent need for culturally safe, community-based alternatives to emergency care.
• Intervention strategies must be tailored to address the unique needs of rural populations experiencing SGBV.