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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 PMCID: PMC11255752 DOI: 10.1161/jaha.123.033515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of MedicineOnslow Memorial HospitalJacksonvilleNC
| | - Sanchit Duhan
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | | | | | - Amro Taha
- Department of MedicineWeiss Memorial HospitalChicagoIL
| | | | - Yasar Sattar
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Bijeta Keisham
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | - Shafaqat Ali
- Department of Internal MedicineLouisiana State UniversityShreveportLA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of MedicineBridgetownBarbados
| | - Minahil Naeem
- Department of Internal MedicineKing Edward Medical UniversityLahorePakistan
| | - Ayesha Shaik
- Department of CardiologyHartford HospitalHartfordCT
| | - Sudarshan Balla
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars Sinai Medical CenterLos AngelesCA
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Marchand M, McCallum RK, Marchand K, Anand SS, Moulson N, Taylor CM, Dulay D. Indigenizing Cardiac Rehabilitation: The Role for Cultural Adaptation. Can J Cardiol 2024; 40:1069-1076. [PMID: 38081512 DOI: 10.1016/j.cjca.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 04/14/2024] Open
Abstract
Cardiac rehabilitation (CR) is an integral component of cardiovascular care, which reduces morbidity and mortality, and improves quality of life. Largely as a result of Canada's colonial history, Indigenous communities face higher rates of cardiovascular morbidity and mortality. Indigenous Peoples in Canada have a unique cultural, historical, and geographic context that limits access to high-quality cardiovascular care, including CR, which has traditionally been delivered in an urban, hospital-based setting. Culturally adapted, holistic exercise and diet programs and CR programs have been successful in Canada, Australia, and New Zealand, demonstrating acceptability to the community, safety, and improvements in cardiovascular risk factors. Key components of a successful culturally adapted CR program include program leadership and development by Indigenous community members and key partners, cultural sensitivity training for health care providers and financial and geographic accessibility. Encouragement of traditional practices, including healthy traditional dietary practices, and recognizing land-based activities as exercise have also proved important in the successful delivery of CR in Indigenous communities. This review summarizes the current evidence for culturally adapted CR programming for Indigenous patients, including strategies to engage communities in education on cardiovascular risk-factor optimization and to promote guideline-based exercise and diet through an Indigenous lens.
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Affiliation(s)
- Miles Marchand
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Member of the Syilx Okanagan First Nation, British Columbia, Canada.
| | - Rylan K McCallum
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Member of the Manitoba Métis Federation, Manitoba, Canada
| | - Keegan Marchand
- Member of the Syilx Okanagan First Nation, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn M Taylor
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daisy Dulay
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Shavadia JS, Okpalauwaekwe U, Kim M, Orvold J, Pearce C, King A, Ametepee K, Haddad H. Contemporary Outcomes of Acute Coronary Syndromes in Indigenous Compared With Non-Indigenous Patients: A Northern Saskatchewan Perspective. Can J Cardiol 2024:S0828-282X(24)00354-4. [PMID: 38729604 DOI: 10.1016/j.cjca.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In patients presenting with an acute coronary syndrome (ACS), the impact of efforts to bridge historical care gaps between Indigenous and non-Indigenous patients remains limited. METHODS For consecutive ACS presentations (ST-segment elevation myocardial infarction [STEMI] and non-ST-segment elevation myocardial infarction [NSTEMI]/unstable angina [UA], respectively) at the Royal University Hospital, Saskatoon, we compared self-identified Indigenous and non-Indigenous patients' demographics, treatments, and all-cause mortality (in-hospital and within 3 years). We used propensity score inverse probability weighting to mitigate confounding and Cox regression models to estimate the adjusted hazard ratio (aHR) for all-cause mortality. RESULTS Of 3946 ACS patients, 37.2% (n = 1468) were STEMI, of whom 11.3% (n = 166) were Indigenous. Of the NSTEMI/UA (n = 2478), 12.6% (n = 311), were Indigenous. Overall, Indigenous compared with non-Indigenous patients were likely to be younger, female, have higher risk burden, and live more remotely; Indigenous STEMI patients triaged to primary percutaneous coronary intervention had longer times from first medical contact to device, and Indigenous NSTEMI/UA patients more likely to present with heart failure, cardiac arrest, and cardiogenic shock. No significant differences were noted for in-hospital mortality (STEMI 8.4% vs 5.7% [P = 0.16], NSTEMI/UA 1.9% vs 1.6% [P = 0.68]), although in follow-up, Indigenous STEMI patients were associated with a higher all-cause mortality risk (aHR 1.98, 95% CI 1.19-3.31; P = 0.009) with no between-group differences evident for NSTEMI/UA (aHR 1.03, 95% CI 0.63 1.69; P = 0.91). CONCLUSIONS Indigenous compared with non-Indigenous patients presenting with an ACS had higher cardiovascular risk profiles and consequent residual mortality risk. Improving primary care and intensifying secondary risk reduction, particularly for Indigenous patients, will substantially modify ACS outcomes in Saskatchewan.
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Affiliation(s)
- Jay S Shavadia
- Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Udoka Okpalauwaekwe
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Minyoung Kim
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jason Orvold
- Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Colin Pearce
- Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexandra King
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Pewaseskwan Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kehinde Ametepee
- Pewaseskwan Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Haissam Haddad
- Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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4
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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5
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Anderson M. The denial of racism is racism itself. CMAJ 2023; 195:E197. [PMID: 36746487 PMCID: PMC9904813 DOI: 10.1503/cmaj.147823-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Marcia Anderson
- Executive director, Indigenous Academic Affairs, Ongomiizwin Indigenous Institute of Health and Healing; vice-dean, Indigenous Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
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6
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Vervoort D, Kimmaliardjuk DM, Ross HJ, Fremes SE, Ouzounian M, Mashford-Pringle A. Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review. CJC Open 2022; 4:782-791. [PMID: 36148252 PMCID: PMC9486860 DOI: 10.1016/j.cjco.2022.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Indigenous peoples in Canada are at an increased risk of cardiovascular disease compared to non-Indigenous people. Contributing factors include historical oppression, racism, healthcare biases, and disparities in terms of the social determinants of health. Access to and inequity in cardiovascular care for Indigenous peoples in Canada remain poorly studied and understood. A rapid review of the literature was performed using the PubMed/MEDLINE, Web of Science, and Indigenous Studies Portal (iPortal) databases to identify articles describing access to cardiovascular care for Indigenous peoples in Canada between 2002 and 2021. Included articles were presented narratively in the context of delays in seeking, reaching, or receiving care, or as disparities in cardiovascular outcomes, and were assessed for their successful engagement in indigenous health research using a preexisting framework. Current research suggests that gaps most prominently present as delays in receiving care and as poorer long-term outcomes. The literature is concentrated in Alberta, Manitoba, and Ontario, as well as among First Nations people, and is largely rooted in a biomedical worldview. Additional community-driven research is required to better elucidate the gaps in access to holistic cardiovascular care for Indigenous peoples in Canada. Healthcare professionals, researchers, and policymakers should reflect further upon their actions and privilege, educate themselves about historical facts and the Truth and Reconciliation Commission, tackle prevailing disparities and systemic barriers in the healthcare systems, and develop culturally safe and ethically appropriate healthcare interventions to improve the health of all Indigenous peoples in Canada.
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Affiliation(s)
- Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, Ontario M5T 3M6, Canada. Tel.: +1-416-989-7874.
| | - Donna May Kimmaliardjuk
- Division of Cardiovascular Surgery, Eastern Health, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Heather J. Ross
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Angela Mashford-Pringle
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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7
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Schultz A, Nguyen T, Sinclaire M, Fransoo R, McGibbon E. Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What's Reconciliation Got to Do With It? CJC Open 2021; 3:S149-S164. [PMID: 34993444 PMCID: PMC8712585 DOI: 10.1016/j.cjco.2021.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/12/2021] [Indexed: 12/04/2022] Open
Abstract
Colonization and enforced genocidal strategies have collectively fractured and changed Indigenous people by attempting to erase and dismiss their voices and knowledge. Nearly a decade ago, we were reminded by Dr Ku Young of the cardiovascular health disparities, in evidence among Indigenous people in Canada. compared with White people. He went on to say that beyond a biomedical understanding of this health status is the ongoing impact of long-standing marginalization and oppression faced by Indigenous people. Limited attention has been afforded to advance our understanding of these colonial impacts on Indigenous people and their heart health. This article contributes to our collective understanding of Indigenous people and their cardiac health by covering the following topics: layers of foundational truths of relevance to healthcare contexts and Indigenous people; a critical reflection of Western (biomedical) perspectives concerning cardiac health among Indigenous people; and materials from 2 studies, funded by the Canadian Institutes of Health Research, in which Indigenous voices and experiences were privileged concerning the heart and caring for the heart. In the final section, 3 topics are offered as starting points for self-reflection and acts of reconciliation within healthcare practice, decision-making, and research: reflections on self and one's worldview; anti-racist healthcare practice; and 2-eyed seeing approaches to work within healthcare contexts. A common thread is the imperative for "un-silencing" Indigenous people's voices, experiences, and knowledge, which is a requirement if addressing the identified cardiovascular health disparities is truly a health priority.
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Affiliation(s)
- Annette Schultz
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
- St Boniface Research Centre, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Cardiac Sciences Manitoba, Asper Clinical Research Institute, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, Faculty of Health Sciences, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
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8
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Vigneault LP, Diendere E, Sohier-Poirier C, Abi Hanna M, Poirier A, St-Onge M. Acute health care among Indigenous patients in Canada: a scoping review. Int J Circumpolar Health 2021; 80:1946324. [PMID: 34320910 PMCID: PMC8330756 DOI: 10.1080/22423982.2021.1946324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
A recent report by the Chief Public Health Officer of Canada demonstrates the inferior health status of Indigenous Peoples in Canada when compared to non-Indigenous populations. This scoping review maps out the available literature concerning acute health care for Indigenous Peoples in Canada in order to better understand the health care issues they face. All existing articles concerning health care provided to Indigenous Peoples in Canada in acute settings were included in this review. The targeted studied outcomes were access to care, health care satisfaction, hospital visit rates, mortality, quality of care, length of stay and cost per hospitalisation. 114 articles were identified. The most studied outcomes were hospitalisation rates (58.8%), length of stay (28.0%), mortality (25.4%) and quality of care (24.6%) Frequently studied topics included pulmonary disease, injuries, cardiovascular disease and mental illness. Indigenous Peoples presented lower levels of satisfaction and access to care although they tend to be over-represented in hospitalisation rates for acute care. Greater inclusion of Indigenous Peoples in the health care system and in the training of health care providers is necessary to ensure a better quality of care that is culturally safe for Indigenous Peoples.
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Affiliation(s)
| | - Ella Diendere
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Canada
| | | | - Margo Abi Hanna
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Annie Poirier
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Maude St-Onge
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
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9
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Issues postopératoires chez les Autochtones au Canada: revue systématique. CMAJ 2021; 193:E1310-E1321. [PMID: 34426452 PMCID: PMC8412424 DOI: 10.1503/cmaj.191682-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Contexte: Il existe d’importantes iniquités en matière de santé chez les populations autochtones au Canada. La faible densité de la population canadienne et les populations en région éloignée posent un problème particulier à l’accès et à l’utilisation des soins chirurgicaux. Aucune synthèse des données sur les issues chirurgicales chez les Autochtones au Canada n’avait été publiée jusqu’à maintenant. Méthodes: Nous avons interrogé 4 bases de données pour recenser les études comparant les issues chirurgicales et les taux d’utilisation chez les adultes des Premières Nations, inuits et métis et chez les adultes non autochtones au Canada. Des évaluateurs indépendants ont réalisé toutes les étapes en parallèle. L’issue primaire était la mortalité; les issues secondaires comprenaient le taux d’utilisation des chirurgies, les complications et la durée du séjour à l’hôpital. Nous avons effectué une méta-analyse pour l’issue primaire à l’aide d’un modèle à effets aléatoires. Nous avons évalué les risques de biais à l’aide de l’outil ROBINS-I. Résultats: Vingt-huit études ont été analysées, pour un total de 1 976 258 participants (10,2 % d’Autochtones). Aucune étude ne portait précisément sur les populations inuites et métisses. Quatre études portant sur 7 cohortes ont fourni des données corrigées sur la mortalité pour 7135 participants (5,2 % d’Autochtones); les Autochtones présentaient un risque de décès après une intervention chirurgicale 30 % plus élevé que les patients non autochtones (rapport de risque combiné 1,30; IC à 95 % 1,09–1,54; I2 = 81 %). Les complications étaient aussi plus fréquentes chez le premier groupe, notamment les infections (RC corrigé 1,63; IC à 95 % 1,13–2,34) et les pneumonies (RC 2,24; IC à 95 % 1,58–3,19). Les taux de différentes interventions chirurgicales étaient plus faibles, notamment pour les transplantations rénales, les arthroplasties, les chirurgies cardiaques et les accouchements par césarienne. Interprétation: Les données disponibles sur les issues postopératoires et le taux d’utilisation de la chirurgie chez les Autochtones au Canada sont limitées et de faible qualité. Elles suggèrent que les Autochtones ont de plus hauts taux de décès et d’issues négatives postchirurgicales et qu’ils font face à des obstacles dans l’accès aux interventions chirurgicales. Ces conclusions indiquent qu’il y a un besoin de réévaluer en profondeur les soins chirurgicaux prodigués aux Autochtones au Canada pour leur assurer un accès équitable et améliorer les issues. Numéro d’enregistrement du protocole: PROSPERO-CRD42018098757.
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Affiliation(s)
- Jason A McVicar
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont.
| | - Alana Poon
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nadine R Caron
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - M Dylan Bould
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Jason W Nickerson
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nora Ahmad
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Chelsey Sheffield
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Caitlin Champion
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Daniel I McIsaac
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
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10
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021; 193:E713-E722. [PMID: 34001549 PMCID: PMC8177941 DOI: 10.1503/cmaj.191682] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration: PROSPERO-CRD42018098757
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Affiliation(s)
- Jason A McVicar
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Alana Poon
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Nadine R Caron
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - M Dylan Bould
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Jason W Nickerson
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
| | - Nora Ahmad
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Chelsey Sheffield
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Caitlin Champion
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
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Scheirer O, Leach A, Netherton S, Mondal P, Hillier T, Lafond G, LaFontaine T, Davis PJ. Outcomes of out of hospital cardiac arrest in First Nations and non-First Nations patients in Saskatoon. CAN J EMERG MED 2020; 23:75-79. [PMID: 33683612 DOI: 10.1007/s43678-020-00015-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION One in nine (11.7%) people in Saskatchewan identify as First Nations. It is known that First Nations people have a higher burden of cardiovascular disease, but not whether outcomes of out of hospital cardiac arrest are different. METHODS/METHODOLOGY We reviewed pre-hospital and inpatient records of patients with out of hospital cardiac arrest between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with out of hospital cardiac arrest of presumed cardiac origin occurring in the catchment area of Saskatoon's emergency medical services (EMS). Variables of interest included age, gender, First Nations status, EMS response times, bystander cardiopulmonary resuscitation (CPR), and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. RESULTS In all, 372 patients sustained out of hospital cardiac arrest, of which 27 were status First Nations. There were no differences between First Nations and non-First Nations patients in terms of shockable rhythms (24% vs 26%; p = 0.80), ROSC (42% vs 41%; p = 0.87), survival to hospital admission (27% vs 33%; p = 0.53), and survival to hospital discharge (15% vs 12%; p = 0.54). First Nations patients with out of hospital cardiac arrest were significantly younger (mean age 46 vs. 65 years; p < 0.0001) and had shorter EMS response times (median times 5.3 vs. 6.2 min; p = 0.01) when compared to non-First Nations patients. CONCLUSIONS In Saskatoon, First Nations patients with out of hospital cardiac arrest appear to have similar survival rates when compared with non-First Nations patients. However, First Nations patients sustaining out of hospital cardiac arrest were significantly younger than their non-First Nations counterparts. This highlights a significant public health issue.
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Affiliation(s)
- Owen Scheirer
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Andrew Leach
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Stuart Netherton
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Prosanta Mondal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Gabe Lafond
- First Nations and Métis Health Council, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Tania LaFontaine
- First Nations and Métis Health Council, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Philip J Davis
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
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Pace R, Harris S, Parry M, Zaran H. Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program. CJC Open 2020; 2:547-554. [PMID: 33305215 PMCID: PMC7711009 DOI: 10.1016/j.cjco.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Data on the extent of CVD risk-factor management in FN peoples with T2DM in Canada are scarce. Methods A T2DM registry with data from 7 FN communities in Canada was utilized to identify individuals eligible for primary and secondary CVD prevention. Proportions of individuals meeting clinical practice guideline-specified targets (hemoglobin A1c ≤7.0%; blood pressure ≤130/80 mm Hg; low-density lipoprotein ≤2 mmol/L) were calculated. Prescription of recommended cardioprotective medications (antithrombotic medication, lipid-lowering agents, renin-angiotensin-aldosterone system inhibitors, and beta-blockers) among those with CVD was assessed. χ2 tests were employed to evaluate differences between CVD prevention groups and sexes. Results Of the 2098 individuals in the registry, 18% had documented CVD (female: male = 1.12). Overall, <10% met all 3 clinical practice guideline targets. Attainment of hemoglobin A1c and blood pressure targets was comparable between primary and secondary CVD prevention groups, with<50% achieving targets. A greater proportion of the secondary prevention group met low-density lipoprotein targets compared to those without CVD (61.6% vs 40.9%, P < 0.01). In the secondary prevention group, beta-blockers were prescribed to only 20%, and <60% were prescribed antithrombotics, lipid-lowering medications, or agents targeting the renin-angiotensin-aldosterone system; <2% were prescribed medications from all 4 classes of cardioprotective medications. Conclusions Primary and secondary CVD prevention recommendations for individuals with T2DM are not being met for an alarmingly high proportion of FN peoples. These findings serve as an urgent call for proactive measures to reduce CVD events and related mortality in this high-risk population.
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Affiliation(s)
- Romina Pace
- Centre for Outcomes Research & Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stewart Harris
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Corresponding author: Dr Stewart B. Harris, Centre for Studies in Family Medicine, Western University, The Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario N6A 3K7, Canada. Tel.: +1-519-858-5028; fax: +1-519-858-5029.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Harsh Zaran
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Schultz A, Dahl L, McGibbon E, Brownlie J, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JAV, Prior HJ, Sinclaire M, Throndson K, Fransoo R. Differences in coronary artery disease complexity and associations with mortality and hospital admissions among First Nations and non-First Nations patients undergoing angiography: a comparative retrospective matched cohort study. CMAJ Open 2020; 8:E685-E694. [PMID: 33139389 PMCID: PMC7608944 DOI: 10.9778/cmajo.20190171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND First Nations people are more likely than the general population to experience long-term adverse health outcomes after coronary angiography. Our aim was to quantify the extent of coronary artery disease among First Nations and non-First Nations patients undergoing angiography to investigate differences in coronary artery disease and related health disparities. METHODS We conducted a retrospective matched cohort study to compare health outcomes of First Nations and non-First Nations adult patients (> 18 yr) who underwent index angiography between Apr. 1, 2008, and Mar. 31, 2012, in Manitoba, Canada. The SYNTAX Score was used to measure and compare severity of coronary artery disease between groups. Primary outcomes of all-cause and cardiovascular mortality were compared between groups using Cox proportional hazard models adjusted by SYNTAX Score results and weighted by the inverse probability of being First Nations. Secondary outcomes included all-cause and cardiovascular-related hospital admissions. RESULTS The cohort consisted of 277 matched pairs of First Nations and non-First Nations patients undergoing angiography; the average age of patients was 56.0 (standard deviation 11.7) years. The median SYNTAX Score results and patient distributions across categories in the matched paired cohort groups were not significantly different. Although proportionally First Nations patients showed worse health outcomes, mortality risks were similar in the weighted sample, even after controlling for revascularization and SYNTAX Score results. Secondary outcomes showed that adjusted risks for hospital admission for acute myocardial infarction (adjusted hazard ratio [HR] 3.03, 95% confidence interval [CI] 1.40-6.55) and for congestive heart failure (adjusted HR 3.84, 95% CI 1.37-10.78) were significantly higher among First Nations patients in the weighted sample. INTERPRETATION The extent of coronary artery disease among matched cohort groups of First Nations and non-First Nations patients appears similar, and controlling for baseline sociodemographic characteristics, coronary artery disease risk factors and SYNTAX Score results explained higher mortality risk and most hospital admissions among First Nations patients. Although there is a need to decrease risk factors for coronary artery disease among First Nations populations, addressing individuals' behaviour without considering root causes underlying risk factors for coronary artery disease will fail to decrease health outcome disparities among First Nations patients undergoing angiography.
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Affiliation(s)
- Annette Schultz
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
| | - Lindsey Dahl
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Elizabeth McGibbon
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Jarvis Brownlie
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Catherine Cook
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Basem Elbarouni
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Alan Katz
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Thang Nguyen
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Jo-Ann V Sawatzky
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Heather J Prior
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Moneca Sinclaire
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Karen Throndson
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Randy Fransoo
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
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Sem M, Lin S, Reading J, Mohindra R. The need to review knowledge gaps on sudden cardiac death in Canadian Indigenous populations. CAN J EMERG MED 2020; 22:E1. [PMID: 32037999 DOI: 10.1017/cem.2019.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Sem
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - Steve Lin
- Emergency Physician, Trauma Team Leader, Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON
- Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
- Assistant Professor, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Jeff Reading
- British Columbia First Nations Health Authority Chair in Heart Health & Wellness, St. Paul's Hospital
- Director, I-HEART Centre, Division of Cardiology, St. Paul's Hospital, Providence Health Care, Vancouver, BC
- Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
- Professor, Emeritus, Faculty of Health Sciences, University of Victoria, Victoria, BC
- Adjunct Professor, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON
| | - Rohit Mohindra
- Emergency Physician and Research Scientist, Department of Emergency Medicine, North York General Hospital, Toronto, ON
- Visiting Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
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Dahl L, Schultz A, McGibbon E, Brownlie J, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Prior HJ, Fransoo R. Cardiovascular Medication Use and Long-Term Outcomes of First Nations and Non-First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study. J Am Heart Assoc 2019; 8:e012040. [PMID: 31405352 PMCID: PMC6759915 DOI: 10.1161/jaha.119.012040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline‐recommended cardiovascular medication use. Methods and Results Retrospective analysis of administrative health data investigated patterns of medication dispensation during the first year after index angiography among patients in Manitoba, Canada. Medication possession ratios (MPRs) reflecting the percentage of days in which medications were supplied were calculated separately for β‐blockers, angiotensin‐converting enzyme inhibitors, statins, and antiplatelets (clopidogrel). Patients were assigned to 1 of 4 categories: (1) not dispensed (0% MPR), (2) low (1–39% MPR), (3) intermediate (40–79% MPR), (4) high (≥80% MPR). Cox regression models that adjusted for MPR categories were used to explore the association between FN patients and both 5‐year all‐cause mortality and cardiovascular mortality. FN patients were less likely to have an intermediate MPR (odds ratio: 0.75; 95% CI, 0.57–0.99) or a high MPR (odds ratio: 0.64; 95% CI, 0.50–0.81) for statin medications than non‐FN patients. FN patients also had higher adjusted risks of all‐cause and cardiovascular mortality than non‐FN patients (hazard ratio, all‐cause: 1.54 [95% CI, 1.25–1.89]; cardiovascular: 1.62 [95% CI, 1.16–2.25]). Conclusions FN status was independently associated with intermediate and high MPRs for statins during the first year following index angiography among patients with known ischemic heart disease. Differences in MPR categories did not explain the disparity in all‐cause and cardiovascular mortality between the 2 populations. Reduction of cardiovascular disparities may be best addressed using primary prevention strategies that include decolonizing policies and practices.
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Affiliation(s)
- Lindsey Dahl
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada
| | - Annette Schultz
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada
| | - Elizabeth McGibbon
- Faculty of Health Sciences St. Francis Xavier University Antigonish Canada
| | | | - Catherine Cook
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada
| | - Basem Elbarouni
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada.,St. Boniface General Hospital Winnipeg Canada
| | - Alan Katz
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada.,Manitoba Centre for Health Policy Winnipeg Canada
| | - Thang Nguyen
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada.,St. Boniface General Hospital Winnipeg Canada
| | - Jo Ann Sawatzky
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada
| | - Moneca Sinclaire
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada
| | | | - Heather J Prior
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada.,Manitoba Centre for Health Policy Winnipeg Canada
| | - Randy Fransoo
- Rady Faculty of Health Sciences University of Manitoba Winnipeg Canada.,Manitoba Centre for Health Policy Winnipeg Canada
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Hong Y, Graham MM, Rosychuk RJ, Southern D, McMurtry MS. The Effects of Acute Atmospheric Pressure Changes on the Occurrence of ST-Elevation Myocardial Infarction: A Case-Crossover Study. Can J Cardiol 2019; 35:753-760. [PMID: 31151711 DOI: 10.1016/j.cjca.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Few studies have explored the influence of short-term exposure to atmospheric pressure changes on the abrupt onset of ST-elevation myocardial infarction (STEMI). We sought to evaluate the association between acute atmospheric pressure changes and the occurrence of STEMI. METHODS We studied STEMI patients from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) from March 1, 2002 to December 31, 2016 in a case-crossover study design. Each case was matched with control intervals according to the same day of week, month, and year. All STEMI patients were linked with the nearest weather station within a 40-km radius according to residential postal code. The effect of exposure to air pressure changes, rate of air pressure changes, acute air pressure increase, and acute air pressure decrease 1 day to 7 days earlier on the onset of STEMI were analyzed with conditional logistic regression. All models were adjusted with daily average temperature, relative humidity, and average levels of 5 air pollutants. RESULTS In 11,379 STEMI patients, positive associations with the onset of STEMI were only found at 7 days after exposure to acute air pressure decrease (odds ratio, 1.12; 95% confidence interval, 1.03-1.21), which was consistent in sensitivity and subgroup analyses. All the other models showed no evidence of statistically significant associations. CONCLUSIONS Acute air pressure decrease is associated with higher odds of a STEMI event 7 days after exposure. Weather advisories might be issued when atmospheric pressure decrease occurs.
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Affiliation(s)
- Yongzhe Hong
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Michelle M Graham
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda J Rosychuk
- O'Brien Institute for Public Health and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Southern
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Sean McMurtry
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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Hong Y, Graham MM, Southern D, McMurtry MS. The Association between Chronic Obstructive Pulmonary Disease and Coronary Artery Disease in Patients Undergoing Coronary Angiography. COPD 2019; 16:66-71. [PMID: 30897970 DOI: 10.1080/15412555.2019.1566894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of morbidity and mortality. There are conflicting results regarding the association between COPD and CAD. We sought to measure the association between COPD and angiographically diagnosed CAD in a population-based cohort. We performed a retrospective analysis using data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a prospectively collected registry capturing all patients undergoing coronary angiography in Alberta, Canada, since 1995. We included adult patients who had undergone coronary angiogram between April 1, 2007 and March 31, 2014. CAD was present if at least one coronary artery had a significant stenosis ≥50%. COPD was present if the patient had a documented COPD history and was prescribed bronchodilators or inhaled steroids. We evaluated the association between COPD and CAD using univariable and multivariable logistic regression. There were 26,137 patients included with a mean age of 63.3 ± 12.2 years, and 19,542 (74.8%) were male. The crude odds ratio (OR) of having CAD was 0.83 (95% CI 0.74-0.92) for patients with COPD compared to those without COPD. The adjusted OR was 0.75 (95% CI 0.67-0.84) after controlling for age, sex, smoking history, body mass index, hypertension, diabetes, hyperlipidemia, peripheral artery disease and cardiac family history. In patients undergoing coronary angiography, COPD was negatively associated with CAD with and without the adjustment for classic risk factors. COPD patients should be properly examined for heart disease to reduce premature mortality.
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Affiliation(s)
- Yongzhe Hong
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
- b The Second Affiliated Hospital of Shantou University Medical College , Shantou , Guangdong , China
| | - Michelle M Graham
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
| | - Danielle Southern
- c O'Brien Institute for Public Health and Department of Community Health Sciences , University of Calgary , Calgary , Alberta , Canada
| | - Michael Sean McMurtry
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
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Schultz A, Dahl L, McGibbon E, Brownlie J, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Fransoo R. Health Outcome and Follow-up Care Differences Between First Nation and Non-First Nation Coronary Angiogram Patients: A Retrospective Cohort Study. Can J Cardiol 2018; 34:1333-1340. [PMID: 30269830 DOI: 10.1016/j.cjca.2018.07.418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND First Nations (FN) people experience high rates of ischemic heart disease (IHD) morbidity and mortality. Increasing access to angiography may lead to improved outcomes. We compared various outcomes and follow-up care post-index angiography between FN and non-FN patients. METHODS All index angiography patients in Manitoba were identified between April 1, 2000 and March 31, 2009 and categorized into acute myocardial infarction (AMI) or non-AMI groups based on whether their angiogram occurred within 7 days of an AMI. Cox proportional hazard models estimated associations between FN status and outcomes related to mortality, subsequent hospitalizations, revascularizations, and physician visits. RESULTS Cardiovascular mortality was higher among FN patients in the non-AMI group (hazard ratio [HR] = 1.50, 95% confidence interval [CI], 1.17-1.94) and in the AMI group (HR = 1.57, 95% CI, 1.05-2.35). FN patients were also more likely to have a subsequent hospitalization for AMI (HR = 2.26, 95% CI, 1.79-2.85) in the non-AMI group. FN patients in the non-AMI group were less likely to receive percutaneous coronary intervention (HR = 0.85, 95% CI, 0.73-0.99) and more likely to undergo coronary artery bypass graft (HR = 1.26, 95% CI, 1.10-1.45). FN patients in both groups were less likely to visit a cardiologist/cardiac surgeon, internal medicine specialist, or family physician within 3 months and 1 year of angiography. CONCLUSIONS Cardiovascular health and follow-up care outcomes of FN and non-FN patients who undergo angiography are not the same. Addressing Indigenous determinants of health are necessary to improve cardiovascular outcomes.
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Affiliation(s)
- Annette Schultz
- College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Lindsey Dahl
- College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Jarvis Brownlie
- Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Cook
- Indigenous Health, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada, First Nations, Métis and Inuit Health, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basem Elbarouni
- St. Boniface General Hospital, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, and College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- St. Boniface General Hospital, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jo Ann Sawatzky
- College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Throndson
- St. Boniface General Hospital, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, and College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada
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Equality of care between First Nations and non-First Nations patients in Saskatoon emergency departments. CAN J EMERG MED 2018; 21:111-119. [DOI: 10.1017/cem.2018.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveStudies show that First Nations patients have worse health outcomes than non-First Nations patients, raising concerns that treatment within the healthcare system, including emergency care, is inequitable.MethodsWe performed a retrospective chart review of Status First Nations and non-First Nations patients presenting to two emergency departments in Saskatoon, Saskatchewan with abdominal pain and a Canadian Triage and Acuity Scale score of 3. From 190 charts (95 Status First Nations and 95 non-First Nations), data extracted included time to doctor, time to analgesia, length of stay, specialist consult, bloodwork, imaging, physical exam and history, and disposition. Univariate comparisons and multiple regression modelling were performed to compare care outcomes between patient groups. Equivalence testing comparing time intervals was also undertaken.ResultsNo statistically significant differences in presentation characteristics were observed, although Status First Nations subjects showed a greater tendency towards weekend presentation and younger age. Care parameters were similar, although a marginally significant difference was observed in Status First Nations versus non-First Nations subjects for imaging (46% versus 60%, p=0.06), which resolved on adjustment for age and weekend presentation. Time to physician was found to be similar among First Nations patients on equivalence testing within a 15-minute margin.ConclusionIn this study, First Nations patients presenting with abdominal pain did not receive delayed care. There were no detectable differences in the time-related care parameters/variables that were provided relative to non-First Nations patients. Meaningful and important qualitative factors need to be examined in the future.
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Schultz ASH, Dahl L, McGibbon E, Brownlie RJ, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Fransoo R. Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients. BMJ Open 2018; 8:e020856. [PMID: 29581209 PMCID: PMC5875607 DOI: 10.1136/bmjopen-2017-020856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. SETTING Population-based, secondary analysis of provincial administrative health data. PARTICIPANTS All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). RESULTS FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lindsey Dahl
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - R Jarvis Brownlie
- Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Cook
- Indigenous Health, Rady Faculty of Health Sciences (RFHS), First Nations, Métis and Inuit Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basem Elbarouni
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jo Ann Sawatzky
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Throndson
- Clinical Nurse Specialist Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
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Smylie J, O'Brien K, Xavier CG, Anderson M, McKnight C, Downey B, Kelaher M. Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study. Canadian Journal of Public Health 2018; 109:117-127. [PMID: 29981069 PMCID: PMC5904243 DOI: 10.17269/s41997-018-0034-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/18/2017] [Indexed: 12/16/2022]
Abstract
CONTEXT Cardiovascular diseases (CVD) are a leading cause of illness and death for Indigenous people in Canada and globally. Appropriate medication can significantly improve health outcomes for persons diagnosed with CVD or for those at high risk of CVD. Poor health literacy has been identified as a major barrier that interferes with client understanding and taking of CVD medication. Strengthening health literacy within health services is particularly relevant in Indigenous contexts, where there are systemic barriers to accessing literacy skills. OBJECTIVE The aim of this study is to test the effect of a customized, structured health literacy educational program addressing CVD medications. METHODS Pre-post-design involves health providers and Indigenous clients at the De dwa da dehs nye>s Aboriginal Health Centre (DAHC) in Ontario, Canada. Forty-seven Indigenous clients with or at high risk of CVD received three educational sessions delivered by a trained Indigenous nurse over a 4- to 7-week period. A tablet application, pill card and booklet supported the sessions. Primary outcomes were knowledge of CVD medications and health literacy practices, which were assessed before and after the programe. RESULTS Following the program compared to before, mean medication knowledge scores were 3.3 to 6.1 times higher for the four included CVD medications. Participants were also more likely to refer to the customized pill card and booklet for information and answer questions from others regarding CVD. CONCLUSIONS This customized education program was highly effective in increasing medication knowledge and health literacy practice among Indigenous people with CVD or at risk of CVD attending the program at an urban Indigenous health centre.
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Affiliation(s)
- Janet Smylie
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Kristen O'Brien
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada
| | - Chloé G Xavier
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada
| | - Marcia Anderson
- Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Bernice Downey
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Smylie J, Firestone M. Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada. STATISTICAL JOURNAL OF THE IAOS 2016; 31:67-87. [PMID: 26793283 PMCID: PMC4716822 DOI: 10.3233/sji-150864] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Canada is known internationally for excellence in both the quality and public policy relevance of its health and social statistics. There is a double standard however with respect to the relevance and quality of statistics for Indigenous populations in Canada. Indigenous specific health and social statistics gathering is informed by unique ethical, rights-based, policy and practice imperatives regarding the need for Indigenous participation and leadership in Indigenous data processes throughout the spectrum of indicator development, data collection, management, analysis and use. We demonstrate how current Indigenous data quality challenges including misclassification errors and non-response bias systematically contribute to a significant underestimate of inequities in health determinants, health status, and health care access between Indigenous and non-Indigenous people in Canada. The major quality challenge underlying these errors and biases is the lack of Indigenous specific identifiers that are consistent and relevant in major health and social data sources. The recent removal of an Indigenous identity question from the Canadian census has resulted in further deterioration of an already suboptimal system. A revision of core health data sources to include relevant, consistent, and inclusive Indigenous self-identification is urgently required. These changes need to be carried out in partnership with Indigenous peoples and their representative and governing organizations.
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Affiliation(s)
- Janet Smylie
- Well Living House Action Research Centre for Indigenous Infant Child and Family Health and Wellbeing, Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto CIHR Applied Public Health Chair in Indigenous Health Knowledge and Information, Toronto, ON, Canada
| | - Michelle Firestone
- Well Living House Action Research Centre for Indigenous Health and Wellbeing, Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, ON, Canada
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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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