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

Abstract

T he shifting landscape of Canadian cardiovascular health over the last couple of decades presents 2 notable trends. First, the incidence of coronary artery disease and related mortality among the general population continue to decrease, 1 which is attributed to improvements in lifestyle factors, diagnostic procedures and treatments. [2][3][4][5] Second, before the 1980s, rates of coronary

Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What’s Reconciliation Got to Do With It?

“…Once greater burden of a disease is identified, there is a discussion of cardiovascular risk factors that commonly include rates of obesity, hypertension, hyperlipidemia, atherosclerosis, diabetes, diet, exercise, tobacco use, and poverty. Reported rates are usually higher among Indigenous People in comparison to other (non-Indigenous) people, which then informs strategies to assist individuals in addressing the high rates of risk factors 5,10,11,13 . McGibbon and colleagues 15 , suggest an alternate follow-up to the evidence of higher rates among a group of people, by asking the questionwhy is it that this particular group has higher rates of risk factors in the first place?…”

“… 2 In our study titled Debwewin—The Truth of Our Hearts, the focus was on diagnostic angiograms as an entry point into cardiovascular care. We explored risk factors, related treatments, and access to care, along with health outcomes, 9 , 10 , 11 and like many others have done, we compared First Nations (Indigenous people) with other people (predominantly non-Indigenous); this comparison revealed higher rates of illness, sex-based differences, and greater disease burden among First Nations people, in comparison to all other Manitobans. 9 , 10 , 11 Epidemiologically defined disparities are useful evidence, but what to do with this awareness is our current quandary.…”

“…We explored risk factors, related treatments, and access to care, along with health outcomes, 9 , 10 , 11 and like many others have done, we compared First Nations (Indigenous people) with other people (predominantly non-Indigenous); this comparison revealed higher rates of illness, sex-based differences, and greater disease burden among First Nations people, in comparison to all other Manitobans. 9 , 10 , 11 Epidemiologically defined disparities are useful evidence, but what to do with this awareness is our current quandary. 15 , 58 That is, what questions need to be asked, and how do we understand and act on evidence that demonstrates the existence of health disparities and inequities?…”

“…and ongoing oppressive marginalization of Aboriginal Peoples underlies the growing health burden. Since then, Canadian health researchers' contributions include reporting on rates of cardiovascular diseases, related treatments, cardiac risk factors, and health outcomes [2][3][4][5][6][7][8][9][10][11][12] . While contributions rooted in biomedical perspectives are expected, there is notably limited attention given to understanding the impacts of historical and ongoing colonization and racism [13][14][15] .…”

“…Since then, Canadian health researchers’ contributions include reporting on rates of cardiovascular diseases, related treatments, cardiac risk factors, and health outcomes. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Although contributions rooted in biomedical perspectives are expected, there is notably limited attention given to understanding the impacts of historical and ongoing colonization and racism. 13 , 14 , 15 The growing burden of cardiovascular disease among Indigenous peoples in Canada has yet to be effectively addressed by drawing on evidence and perspectives derived from biomedical perspectives.…”