Avoidable hospitalizations among racialized groups in Canada: Results from the 2016 Canadian Census Health and Environment Cohort

Background Ambulatory care sensitive conditions (ACSCs) are illnesses that can be effectively treated and managed in primary care settings. Hospitalizations for ACSCs are therefore considered avoidable and may indicate poor access to quality primary care. This study examined trends in avoidable hospitalizations in Canada among racialized groups. Data and methods The 2016 Canadian Census Health and Environment Cohort was used to estimate annual age-standardized hospitalization rates (ASHRs) for ACSCs among people aged 10 to 74 from 2016/2017 to 2021/2022. ASHRs were disaggregated by sex and racialized group. Rate ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess relative inequality. Logistic regression models were run, adjusting for age, sex, immigrant status, household income, and education. Results Across all study years, the odds of avoidable hospitalizations were significantly higher among males, Black people, and non-immigrants, and significantly lower among Chinese people and people in the category "other racialized groups not included elsewhere." In 2020/2021, during the COVID-19 pandemic, RRs for Black females compared with non-racialized females decreased (2019/2020: RR=1.12, 95% CI=1.07 to 1.61; 2020/2021: RR=0.99, 95% CI=0.94 to 1.04), while they significantly increased for Black males compared with non-racialized males (2019/2020: RR=1.30, 95%CI=1.25 to 1.35; 2020/2021: RR=1.63, 95% CI=1.41 to 1.88). Interpretation This study reveals inequalities in avoidable hospitalizations in Canada, pronounced for the Black population compared with the non-racialized population, especially during the pandemic (2020/2021 and 2021/2022). Future studies examining the factors driving these inequalities (e.g., access to primary care, most prevalent conditions, geography) may inform targeted interventions.