Di erences in glycemic control and survival predict higher ESRD rates in diabetic rst nations adults Abstract Purpose: Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and other Saskatchewan residents (OSK) by renal function stage.Methods: Prevalent diabetes cases in 2005/06 were identi ed in Saskatchewan's two largest health regions using administrative databases, and linked with centralized laboratory tests. ey were sub-divided into ve stages of renal function using estimated glomerular ltration rates (eGFR) that were determined in 992 of 2,321 FN (42.7%) and 14,054 of 21,886 OSK (64.2%). Age, sex, urine microalbumin (MA), glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C) and two year mortality risk was compared for all subjects.Results: Diabetic FN were younger (mean age 52.7 vs. 64.2, p<0.0001), more likely to be female (59.6% vs.45.4%, p<0.001), had increased MA (56.6% vs. 48.4%, p<0.0001) and displayed higher mean A1C levels (8.16% vs.7.36%, p<0.0001) than OSK. Despite a larger proportion having eGFR's >60 ml/min (87.0% vs.77.3%, p<0.001), FN were also more likely to have ESRD (2.3% vs.0.8%, p<0.001). Although FN with eGFR's >30 ml/min experienced higher age/sex adjusted mortality risk than OSK, the trends for both adjusted and unadjusted mortality risks for those with advanced pre-ESRD renal failure were lower for FN than for OSK.Conclusions: Elevated rates of ESRD experienced by FN with diabetes are related to poorer glycemic control at all levels of renal function, and lower age-related mortality at advanced stages of chronic kidney disease. ORIGINAL RESEARCH © 2010 CIMClin In E390 Diabetes mellitus is the most common cause of end stage renal disease (ESRD) in Canada [1] but the burden of diabetic ESRD upon indigenous peoples is of particular concern. In 1994, a disproportionate incidence of ESRD was reported among Saskatchewan First Nations (FN) people with diabetes [2] and a recent study shows that such disparities persist [3]. While the mechanisms underlying these observations are incompletely understood, there are two possibilities. First, FN with diabetes may be more prone to the initial development of diabetic glomerulosclerosis, which can lead to ESRD. is is supported by reports that diabetic FN have higher rates of microalbuminuria [4]. Second, FN with early diabetic glomerulosclerosis may progress to ESRD more frequently than others because of a more rapid course and/or lower mortality rates. Although our recent ndings that FN are diagnosed at a a younger age and experience a longer duration between diabetes and ESRD diagnoses are consistent with a di erential mortality e ect [5] other studies report lower survival rates among FN with all-cause advanced chronic kidney disease (CKD) [6].Identifying the mechanisms underlying ethnicity-based di erences in diabetic ESRD is important for understa...

A large literature documents a strong correlation between health and educational outcomes. In this paper we investigate the role of cognitive ability in the health-education nexus. Using NLSY data, we show that one standard deviation increase in cognitive ability is associated with roughly the same increase in health as two years of schooling and that cognitive ability accounts for roughly one quarter of the association between schooling and health. Both schooling and ability are strongly associated with health at low levels but less related or unrelated at high levels. Estimates treating schooling as endogenous to health suggest that much of the correlation between schooling and health is attributable to unobserved heterogeneity; the causal effect of schooling on health is large only for respondents with low levels of schooling and low cognitive ability. An implication is that policies which increase schooling will only increase health to the extent that they increase the education of poorly-educated individuals. Subsidies to college education, for example, are unlikely to increase population health.

BackgroundChronic complications of diabetes can be reduced through optimal glycemic and lipid control as evaluated through measurement of glycosylated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C). We aimed to produce measures of quality of diabetes care in Saskatchewan and to identify sub-groups at particular risk of developing complications.FindingsPrevalent adult cases of diabetes in 2005/06 were identified from administrative databases and linked with A1C and LDL-C tests measured in centralized laboratories. A1C results were performed in 33,927 of 50,713 (66.9%) diabetes cases identified in Saskatchewan, and LDL-C results were performed in 12,031 of 24,207 (49.7%) cases identified within the province's two largest health regions. The target A1C of <= 7.0% and the target LDL-C of <2.5 mmol/L were achieved in 48.3% and 45.1% of diabetes cases respectively. The proportions were lower among those who were female, First Nations, non-urban, younger and in lower income quintiles. The same groups experienced poorer glycemic control (exception females), and poorer lipid control (exception First Nations people). Among non-Aboriginal people, younger diabetic females were least likely to receive lipid lowering agents.ConclusionsLinkage of laboratory with administrative data is an effective method of assessing quality of diabetes care on a population basis and to identify sub-groups requiring particular attention. We found that less than 50% of Saskatchewan people with diabetes achieved optimal glycemic and lipid control. Disparities were most evident among First Nations people and young women. The indicators described can be used to provide standardized information that would support quality improvement initiatives.

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