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Rural-urban differences in use of healthcare resources among patients with ankle sprains in Ontario


Introduction — Ankle sprains can have a significant impact on the short- and long-term well-being of patients. We conducted a study to describe the demographic characteristics of people with an ankle sprain/dislocation treated at physicians’ offices and emergency departments in Ontario, by rurality status; describe the use of healthcare services and the associated costs in this population, by rurality status; and investigate the relation between healthcare costs and rurality status by sex, age, income quintile and season of injury.

Methods — We obtained data on nonfracture injuries of the ankle, foot and toe (International Statistical Classification of Diseases and Related Health Problems, 10th revision, Canada diagnostic code S93) in Ontario between 2003 and 2011 from multiple databases linked through the Institute for Clinical Evaluative Sciences. We used the Rurality Index of Ontario (RIO) as a measure of the rurality level of communities. Demographic characteristics, use of healthcare services and physician billing costs were obtained and compared among 5 RIO categories.

Results — Data were available for 1 787 866 injury encounters. Patients in the most rural RIO category saw specialists least often and had the greatest number of emergency department visits. The mean cost for specialist visits was $141 in the most urban category and $157 in the most rural category (p < 0.05), and the corresponding mean costs for general practitioner visits were $37 and $18, respectively (p < 0.001).

Conclusion — The differences in use of healthcare resources between RIO categories may indicate a lack of access to specialist care in rural areas, thereby necessitating reliance on emergency care. These results may be useful in allocating future resources to better serve rural patients.



Lucas G, Bielska IA, Fong R, Johnson AP. Can J Rural Med. 23(1):7-14. Epub 2018 Jan 1.

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