ObjectivesTo investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada.SettingPopulation-based, secondary analysis of provincial administrative health data.ParticipantsAll 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).ResultsFN 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)ConclusionsIndex 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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Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564
Between 1918 and 1939, about 2400 First Nations people in Canada became enfranchised, gaining full Canadian citizenship and renouncing Indian status. To do so, they had to prove themselves worthy of attain- ing 'white' status in the eyes of the law, a requirement that makes enfranchisement records a rich source for discursive analysis of racial constructions of 'whiteness' and 'Indianness' in the period. Using enfranchisement case files from two Georgian Bay Indian agencies, this article also explores the nascent processes of reserve departure and Aboriginal urbanization occurring in the 1920s and 1930s, as well as the acculturative choices of enfranchisement applicants – their occupations, places of residence, and mobility patterns. Although enfranchisees might seem to have lost rights and benefits attached to Indian status and band membership, in practice virtually all of these rights and benefits were restricted to people living on the reserves, while most people who enfranchised had lived off-reserve for years. The few who chose enfranchisement (approximately 8 per cent of the population in these two agencies) were primarily making an economic choice to obtain their portion of band-owned monies in a lump sum, having already abandoned the reserves in response to the lack of economic opportunities there. The case files contain more than the usual complement of Aboriginal-authored letters, permitting insight into the plans and beliefs of these individuals and some observations about their self-representation vis-à-vis the Department of Indian Affairs. Entre 1918 et 1939, environ 2 400 membres des Premières nations du Canada sont devenus affranchis, obtenant ainsi la citoyenneté canadienne et renonçant à leur statut d'Indien. Pour ce faire, ils devaient démontrer qu'ils étaient dignes d'atteindre le statut de blanc aux yeux de la loi, une exigence qui fait des dossiers d'affranchissement une riche source d'analyses et de débats sur les conceptions raciales à l'égard des blancs et des Indiens à cette époque. À la lumière de dossiers d'affranchissement provenant de deux organismes autochtones de la baie Géorgienne, cet article étudie le processus naissant du départ des réserves et de l'urbanisation des autochtones au cours des années 20 et 30 ainsi que les choix d'acculturation de ceux qui demandaient leur affranchissement : leur profession, leur lieu de résidence et leurs habitudes de déplacement. Bien que l'on puisse croire que les personnes affranchies ont perdu leurs droits et les avantages liés au statut d'indien et de membre d'une bande, en pratique, pratiquement tous ces avantages se limitaient aux personnes vivant dans les réserves, tandis que la plupart des affranchis vivaient à l'extérieur des réserves depuis des années. Les rares personnes qui choisissaient l'affranchissement (environ huit pour cent de la population pour ces deux organismes) faisaient essentiellement un choix économique visant à obtenir un montant forfaitaire équivalent à leur portion des fonds détenus par la bande, ayant déjà abandonné la réserve en raison de l'absence de possibilités de nature économique. Les dossiers comprennent davantage que les habituelles lettres rédigées par des autochtones, ce qui permet d'avoir une perspective des projets et des croyances de ces personnes ainsi que d'émettre certaines observations sur leurs démarches auprès du ministère des Affaires indiennes.
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