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Gmitroski KL, Hastings KG, Legault G, Barbic S. Métis health in Canada: a scoping review of Métis-specific health literature. CMAJ Open 2023; 11:E884-E893. [PMID: 37788865 PMCID: PMC10558240 DOI: 10.9778/cmajo.20230006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Métis are a culturally unique and distinct population, yet little research has evaluated their health separate from the broader Indigenous population. We sought to explore current literature regarding the health of Métis Peoples in Canada and identify potential trends and gaps. METHODS Using the Arksey-O'Malley, 5-stage, scoping review method, we searched PubMed, MEDLINE, iPortal Indigenous Articles Portal Research Tool and pertinent reference lists using the terms "Métis," "health" and "Canada." Two reviewers conducted the initial searches independently, including English articles from 2012 to 2022, and focused on only Métis populations' health within Canada. We described characteristics of the articles and themes for discussion. RESULTS Of the 572 articles we identified, we included a total of 28 articles in this scoping review, of which 16 were quantitative, 9 were qualitative and 3 used mixed methods. Thirteen articles used consultation with Métis communities as part of their methods, and 8 extracted data from national surveys. One article focused on children, while all other articles focused on adults. Nine articles used data from across Canada, 6 were based in Ontario, 5 in Alberta and 4 each in British Columbia and Manitoba. Themes included health, well-being and spirituality; mental health and substance use; health conditions and risk factors; access to adequate health resources; and experiences in health care. INTERPRETATION Métis-specific health research is lacking in Canada, with a gap in volume, subject matter and diversity in the demographics studied. This review illustrates the need for more research with strong community engagement to further explore Métis health and health service needs.
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Affiliation(s)
- Krysta-Leigh Gmitroski
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Katherine G Hastings
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Gabrielle Legault
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Skye Barbic
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
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Durand-Moreau Q, Lafontaine J, Ward J. Work and health challenges of Indigenous people in Canada. Lancet Glob Health 2022; 10:e1189-e1197. [PMID: 35839817 DOI: 10.1016/s2214-109x(22)00203-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
The Truth and Reconciliation Commission of Canada has published 94 calls to action to redress the legacy of residential schools where thousands of Indigenous children have died. The objective of this narrative review is to address some of these calls by summarising the available evidence on work and health issues encountered by Indigenous workers in Canada. We searched seven databases to retrieve studies on Indigenous people, in Canada, and on occupational health as defined by the International Labour Organization. We included 31 studies, from which we found that Indigenous workers are experiencing intersectionality issues: in addition to having differential health issues related to a below-average socioeconomic status, Indigenous workers face discrimination in workplaces that affects their mental health. Indigenous workers might also cumulate occupational and environmental exposures from industries that have settled close to their dwellings (eg, exposure to polychlorobiphenyls). There is a scarcity of studies on major occupational health topics such as occupational cancers or musculoskeletal disorders in Indigenous people.
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Affiliation(s)
- Quentin Durand-Moreau
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Jesse Lafontaine
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Ward
- Faculty of Native Studies, University of Alberta, Edmonton, AB, Canada; Center for Teaching and Learning, University of Alberta, Edmonton, AB, Canada
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Rice C, Jiménez KP, Harrison E, Robinson M, Rinaldi J, LaMarre A, Andrew J. Bodies at the Intersections: Refiguring Intersectionality through Queer Women’s Complex Embodiments. SIGNS 2020. [DOI: 10.1086/709219] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hayward MN, Pace R, Zaran H, Dyck R, Hanley AJ, Green ME, Bhattacharyya O, Zwarenstein M, Emond J, Benoit C, Jebb ML, Harris SB. Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program. Diabetes Res Clin Pract 2020; 162:108066. [PMID: 32045618 DOI: 10.1016/j.diabres.2020.108066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
AIMS TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) partnered with local clinical and community teams in 11 First Nations (FN) communities across Canada to develop quality improvement (QI) initiatives aimed at improving T2DM. METHODS Pre-post mixed-methods case study design was used. The 18-month intervention included community and clinical readiness, development of a community diabetes registry and clinical system, and QI activities. Participants consisted of community members, 18 yrs and older, with diabetes. Changes in clinical outcomes and clinical practice guideline (CPG) recommendations were assessed pre and post intervention using multilevel regression (patients nested within communities) adjusted forindividual andcommunity baseline characteristics. RESULTS No significant change in HbA1c orsBP, but a small reduction indBP(-0.75 mmHg, p < 0.05) and LDL (-0.09 mmol/L, p < 0.05) was observed in 2008 adults with T2DM (mean age: 60·5 (SD:14·6) years; female: 57·2%). Individuals not at CPG targets at baseline had significant reductions in: %HbA1c (N = 616): -0.40 (95%CI:-0·55,-0·24),sBP (N = 561): -7·67 mmHg (95%CI:-9·23, -5·72),dBP (N = 291): -7·46 mmHg (95%CI:-8·69, -6·26), LDL (N = 450): -0·37mmo/l (95%CI:-0·44, -0·29).Annual HbA1c (OR: 1·95; 95%CI:1·66, 2·29), BP (OR: 1·78; 95%CI:1·52, 2·09), LDL (OR: 1·27; 95%CI:1·10, 1·47) and CKD screening (OR: 6·37; 95%CI:5·16, 7·92)increased but retinopathy screening decreased (OR: 0·68; 95%CI:0·57, 0·82). No significant change in foot exams (OR: 0·97; 95%CI:0·76, 1·23) or BMI recordings (OR: 0·96; 95%CI:0·82, 1·12) was seen. Overall, individualsweremorelikely to receive ≥75% of CPG recommended services compared to baseline (OR: 1·51; 95%CI:1·27, 1·80). CONCLUSIONS FORGE AHEAD is the first Canadian study to demonstrate that a FN community-led QI intervention can lead to diabetes improvements.
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Affiliation(s)
| | - Romina Pace
- Centre for Outcomes Research & Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Harsh Zaran
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Roland Dyck
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anthony J Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Michael E Green
- Department of Family Medicine, Public Health Sciences and Policy Studies, and Health Services and Policy Research Institute, Queen's University, Kingston, ON, Canada
| | - Onil Bhattacharyya
- Women's College Hospital, Department of Family and Community Medicine, University of Toronto and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Joelle Emond
- Kateri Memorial Hospital Centre, Kahnawake Mohawk Territory, QC, Canada
| | - Cynthia Benoit
- Conne River Health and Social Services, Conne River, NL, Canada
| | - Marie L Jebb
- Beatrice Wilson Health Centre, Opaskwayak Health Authority, Opaskwayak Cree Nation, Opaskwayak, MB, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Ironside A, Ferguson LJ, Katapally TR, Foulds HJA. Cultural connectedness as a determinant of physical activity among Indigenous adults in Saskatchewan. Appl Physiol Nutr Metab 2020; 45:937-947. [PMID: 31977246 DOI: 10.1139/apnm-2019-0793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cultural connectedness has been associated with increased self-esteem and mental health among Indigenous Peoples. Physical activity is an important contributor to health, although the importance of culture as a determinant of physical activity for Indigenous Peoples in Canada is unclear. The purpose of this study is to evaluate differences in cultural connectedness between Indigenous adults in Canada achieving high and low physical activity levels. Questionnaires evaluated cultural connectedness and physical activity. Indigenous adults were classified into high and low physical activity groups at the specific group mean and as meeting or not meeting musculoskeletal activity guidelines of twice per week. First Nations and specifically Cree/Nehiyaw First Nations adults who were more physically active reported greater identity, spirituality, traditions, exploration, commitment, affirmation/belonging, and overall cultural connectedness. Cultural connectedness elements of commitment, exploration, identity, affirmation/belonging, traditions, spirituality, and overall cultural connectedness were not different between high and low physical activity Métis adults. Musculoskeletal activity was not associated with any elements of cultural connectedness among any Indigenous identity. Cultural connectedness is a protective factor for physical activity among First Nations and Cree/Nehiyaw First Nations adults, but not among Métis adults in Canada. Novelty Musculoskeletal activity was not associated with cultural connectedness. Cultural connectedness is a protective factor of physical activity for First Nations adults. Moving away from one's home community was associated with lower cultural connectedness for Indigenous Peoples.
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Affiliation(s)
- Avery Ironside
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
| | - Leah J Ferguson
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
| | - Tarun R Katapally
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK S4S 0A2, Canada.,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Heather J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
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Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes 2018; 42 Suppl 1:S296-S306. [DOI: 10.1016/j.jcjd.2017.10.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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Kayssi A, Dilkas S, Dance DL, de Mestral C, Forbes TL, Roche-Nagle G. Rehabilitation Trends After Lower Extremity Amputations in Canada. PM R 2016; 9:494-501. [PMID: 27664402 DOI: 10.1016/j.pmrj.2016.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/03/2016] [Accepted: 09/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously. OBJECTIVE To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada. DESIGN Retrospective cohort analysis. SETTING Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals. PARTICIPANTS Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec. INTERVENTIONS Inpatient rehabilitation after lower extremity amputations. MAIN OUTCOME MEASURES Length of stay, discharge destination, and change in total and motor function scores. RESULTS The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, P ≤ .01), older age (beta = 0.2, P ≤ .01), and a history of ischemic heart disease (beta = 3.8, P = .03) or congestive heart failure (beta = 5, P = .04). Patients who spent <7 days in hospital were significantly more likely to have a shorter rehabilitation stay (beta = -4, P = .03). Advanced patient age was the only predictor for hospital readmission (odds ratio = 1.03, P ≤ .01). CONCLUSIONS Rehabilitation length of stay in Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age, undergoing surgery in the province of Manitoba, and having a history of ischemic heart disease or congestive heart failure predict a longer rehabilitation stay. A shorter perioperative hospitalization period (<7 days) predicts a shorter rehabilitation duration. Future studies are needed to explore these issues and to optimize the delivery of rehabilitation services to Canadians after lower extremity amputation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ahmed Kayssi
- Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(∗)
| | - Steven Dilkas
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada(†)
| | - Derry L Dance
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada(‡)
| | - Charles de Mestral
- Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(§)
| | - Thomas L Forbes
- Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(¶)
| | - Graham Roche-Nagle
- Division of Vascular Surgery, University Health Network, University of Toronto, 200 Elizabeth Street, EN, 6th Floor, Rm 218, Toronto, ON M5G 2C4, Canada(‖).
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Foulds HJA, Rodgers CD, Duncan V, Ferguson LJ. A systematic review and meta-analysis of screen time behaviour among North American indigenous populations. Obes Rev 2016; 17:455-66. [PMID: 26990323 DOI: 10.1111/obr.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
Screen time (computer, television, video game and smartphone/tablet activity) is associated with increased obesity and other health risks. This systematic review evaluates screen time among North American Indigenous populations and compares it with that of North American Europeans. Electronic databases (e.g. MEDLINE and EMBASE) were searched, and citations cross-referenced. Included articles reported screen time among First Nations/American Indians, Métis, Inuit/Alaskan Natives or Native Hawaiians. From 788 citations evaluated, 40 identified articles report television, video game, computer and/or overall screen time. Overall screen time was 3.65 ± 1.26 h day(-1) (n = 2,242, 8 articles) among Indigenous children/youth and 3.61 ± 2.95 h day(-1) (n = 155, 1 article) among adults. Among children/youth, 66.0% (n = 11 256, 9 articles) reported less than 2 h day(-1) of television screen time, while only 52.8% (n = 2,458, 1 article) of adults reported this volume. Screen time was generally greater among male population, youth, First Nations/American Indians and overweight/obese individuals. Indigenous children/youth reported greater overall screen time than North American Europeans (4.81 ± 2.84 h day(-1) , n = 1,182 vs. 3.40 ± 2.81 h day(-1) , n = 2,785; 3 articles; p < 0.0001). Screen time is common among North American Indigenous populations. Further research evaluating interventions to reduce screen time and chronic disease risks is required.
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Affiliation(s)
- H J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - C D Rodgers
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - V Duncan
- Health Sciences Library, University of Saskatchewan, Saskatoon, Canada
| | - L J Ferguson
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
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Kayssi A, de Mestral C, Forbes TL, Roche-Nagle G. Predictors of hospital readmissions after lower extremity amputations in Canada. J Vasc Surg 2016; 63:688-95. [DOI: 10.1016/j.jvs.2015.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
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Arbour L, Asuri S, Whittome B, Polanco F, Hegele RA. The Genetics of Cardiovascular Disease in Canadian and International Aboriginal Populations. Can J Cardiol 2015; 31:1094-115. [DOI: 10.1016/j.cjca.2015.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/16/2022] Open
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Tobe SW, Maar M, Roy MA, Warburton DE. Preventing Cardiovascular and Renal Disease in Canada's Aboriginal Populations. Can J Cardiol 2015; 31:1124-9. [DOI: 10.1016/j.cjca.2015.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022] Open
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Reading J. Confronting the Growing Crisis of Cardiovascular Disease and Heart Health Among Aboriginal Peoples in Canada. Can J Cardiol 2015; 31:1077-80. [DOI: 10.1016/j.cjca.2015.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022] Open
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Lyons KJ, Ezekowitz JA, Liu W, McAlister FA, Kaul P. Mortality outcomes among status Aboriginals and whites with heart failure. Can J Cardiol 2014; 30:619-26. [PMID: 24882532 DOI: 10.1016/j.cjca.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown. METHODS The population consisted of all Albertans aged ≥ 20 years with an incident HF hospitalization between 2000 and 2008. Aboriginal status is recorded in the Alberta Health Care Insurance Registry and white ethnicity was determined using previously validated surname analysis algorithms. Cox and logistic regression was used to examine mortality outcomes after adjustment for key variables. RESULTS Compared with whites (n = 42,288), status aboriginal patients with HF (n = 1158) were significantly younger (mean age, 62.6 vs 75.4 years; P < 0.0001) and had higher rates of diabetes (45% vs 29%; P < 0.0001) and chronic obstructive pulmonary disease (40% vs 36%; P < 0.0001) but lower rates of most other comorbidities. Although crude mortality rates were lower in status Aboriginals than in whites at 1 year (22% vs 31%; P < 0.0001) and at 5 years (48% vs 59%; P < 0.0001), after adjustment, status Aboriginals exhibited increased mortality at 1 year (adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.38) and 5 years (adjusted OR, 1.39; 95% CI, 1.16-1.67). Compared with whites, status Aboriginals used more health care resources in the years before and after an incident HF hospitalization but less specialist care. CONCLUSIONS Although status Aboriginals hospitalized for the first time with HF are > 10 years younger, they use more health care resources and have increased short- and long-term mortality compared with their white counterparts.
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Affiliation(s)
- Kristin J Lyons
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
| | - Wei Liu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
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Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples. Can J Cardiol 2013; 29:1629-36. [PMID: 23988340 DOI: 10.1016/j.cjca.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals. METHODS All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events. RESULTS CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals. CONCLUSIONS Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
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