LAUSR

BACKGROUND AND AIMS The availability of alcohol through retail outlets is associated with alcohol-related harms, but few studies have demonstrated a causal relationship. We investigated the association between alcohol availability and alcohol-attributable emergency department (ED) visits in the province of Ontario during a period of deregulation of controls on the number of alcohol outlets. DESIGN Cross-sectional and pre-post design SETTING AND PARTICIPANTS: The study used data from two time-periods: pre-deregulation (2013-14) and post-deregulation (2016-17), to compare rates of ED visits for 513 defined geographic regions in Ontario Canada, called Forward Sortation Areas (FSAs). MEASUREMENTS The primary outcome was the age-standardized rates of alcohol-attributable ED visits. We compiled a list of all alcohol retail outlets in Ontario during 2014 and 2017 and matched them to their corresponding FSA. We fitted mixed-effects Poisson regression models to assess: (a) the cross-sectional association between number of outlets and hours of operation and ED visits; and (b) the impact of deregulation on ED visits using a difference-in-difference approach. FINDINGS Alcohol-attributed ED visits increased 17.8% over the study period: more than twice the rate of increase for all ED visits. Increased hours of operation and numbers of alcohol outlets within an FSA were positively associated with higher rates of alcohol-attributable ED visits. The increase in ED visits attributable to alcohol was 6% (incident rate ratio = 1.06; 95% confidence interval = 1.04-1.08) greater in FSAs that introduced alcohol sales in grocery stores following deregulation compared with FSAs that did not. CONCLUSIONS Deregulation of alcohol sales in Ontario, Canada in 2015 was associated with increased emergency department visits attributable to alcohol.