Trends in health service use among persons with Parkinson’s disease by rurality: a population-based repeated cross-sectional study

Background — The global burden of Parkinson’s disease (PD) has more than doubled over the past 48 three decades, and this trend is expected to continue. Despite generally poorer access to healthcare services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada.

Methods — We conducted a repeated, cross-sectional analysis of persons with prevalent PD aged 40+ years on April 1st of each year from 2000 to 2018 using health administrative databases and calculated the age-sex standardized prevalence of PD. Prevalence of PD was also stratified by rurality and sex. Negative binomial models were used to calculate rate ratios with 95% confidence intervals comparing rates of health service use in rural compared to urban residents in 2018.

Results — The age-sex standardized prevalence of PD in Ontario increased by 0.34% per year (p<0.0001) and was 459 per 100,000 in 2018 (n=33,479), with a lower prevalence in rural compared to urban residents (401 vs. 467 per 100,000). Rates of hospitalizations and family physician visits declined over time in both men and women with PD in rural and urban areas, while rates of emergency department, neurologist, and other specialist visits increased. Adjusted rates of hospitalizations were similar between rural and urban residents (RR=1.04, 95% CI [0.96, 1.12]), while rates of emergency department visits were higher among rural residents (RR=1.35, 95% CI [1.27, 1.42]). Rural residents had lower rates of family physician (adjusted RR=0.82, (95% CI [0.79, 0.84]) and neurologist visits (RR=0.74, 95% CI [0.72, 0.77]).

Interpretation — Lower rates of outpatient health service use among persons residing in rural regions, contrasting with higher rates of emergency department visits suggest inequities in access. Efforts to improve access to primary and specialist care for persons with PD in rural regions are needed.