Geographical disparities in risks of emergency department visits due to intentional self-harm in Florida: a retrospective ecological study

Background Intentional self-harm is a major and growing public health concern in Florida, contributing to thousands of emergency department (ED) visits each year. Although there is evidence that the burden of intentional self-harm varies by geographical location, little is known about disparities of intentional self-harm related ED visit risks in Florida. Understanding these disparities is important for guiding health planning, allocation of resources, and tailoring efforts to mitigate the problem. Therefore, the objectives of this study were to investigate county-level geographic disparities in intentional self-harm-related ED visit risks in Florida. Methods Retrospective ED data were obtained from Florida Health Charts, a publicly available data dashboard maintained by the Florida Department of Health. County-level age-adjusted intentional self-harm-related ED visit risks were calculated for four time periods: 2016–2017, 2018–2019, 2020–2021 and 2022–2023. Tango’s spatial scan statistics were used to identify high-risk clusters. Two sample tests of proportions were used to compare proportions of counties and populations in high-risk clusters between rural and urban areas. Results Age-adjusted intentional self-harm-related ED visit risks decreased from 139.4 to 127.4 visits per 100,000 persons over the study period. Counties in the northwest, northeast, central, and southwest Florida tended to have high risks. Statistically significant high-risk clusters of intentional self-harm ED visits were detected in multiple predominantly rural areas, with seven clusters in 2016–2017 (relative risks (RR) = 1.2–2.2), nine clusters in 2018–2019 (RR = 1.2–2.8), five clusters in 2020–2021 (RR = 1.3–1.9), and six clusters in 2022–2023 (RR = 1.2–1.9). The proportion of counties in high-risk clusters increased from 46.3% in 2020–2021 to 61.2% in 2022–2023. While there were no significant ( p > 0.05) differences between rural and urban counties in earlier periods (2016–2021), by 2022–2023 significantly ( p = 0.001) more rural (81.3%) than urban (42.9%) counties were part of high-risk clusters. Over the study period, 34.3% of the counties were persistently part of high-risk clusters. There was a significantly ( p < 0.0001) higher proportion of rural than urban residents living in high-risk clusters; increasing from 57.2% in 2016–2017 to 71.9% in 2022–2023 in rural areas compared to an increase from 35.0% in 2016–2017 to 41.8% in 2022–2023 in urban areas. Conclusion Despite the declining trend, geographic disparities of intentional self-harm related ED visit risks exist in Florida. Study findings may be useful for informing future studies, targeted intentional self-harm prevention strategies, and need-based resource allocation geared at reducing disparities and improving population health for all.