Disparities in Healthcare Utilisation Rates for Aboriginal and Non-Aboriginal Albertan Residents, 1997–2006: A Population Database Study

Abstract

BackgroundIt is widely recognised that significant discrepancies exist between the health of indigenous and non-indigenous populations. Whilst the reasons are incompletely defined, one potential cause is that indigenous communities do not access healthcare to the same extent. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities.MethodsHealthcare utilisation data over a nine-year period were analysed for a cohort of nearly two million individuals to determine the rates at which Aboriginal and non-Aboriginal populations utilised two specialties (Cardiology and Ophthalmology) in Alberta, Canada. Unadjusted and adjusted healthcare utilisation rates obtained by mixed linear and Poisson regressions, respectively, were compared amongst three population groups - federally registered Aboriginals, individuals receiving welfare, and other Albertans.ResultsHealthcare utilisation rates for Aboriginals were substantially lower than those of non-Aboriginals and welfare recipients at each time point and subspecialty studied [e.g. During 2005/06, unadjusted Cardiology utilisation rates were 0.28% (Aboriginal, n = 97,080), 0.93% (non-Aboriginal, n = 1,720,041) and 1.37% (Welfare, n = 52,514), p = <0.001]. The age distribution of the Aboriginal population was markedly different [2.7%≥65 years of age, non-Aboriginal 10.7%], and comparable utilisation rates were obtained after adjustment for fiscal year and estimated life expectancy [Cardiology: Incidence Rate Ratio 0.66, Ophthalmology: IRR 0.85].DiscussionThe analysis revealed that Aboriginal people utilised subspecialty healthcare at a consistently lower rate than either comparatively economically disadvantaged groups or the general population. Notably, the differences were relatively invariant between the major provincial centres and over a nine year period. Addressing the causes of these discrepancies is essential for reducing marked health disparities, and so improving the health of Aboriginal people.

Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review

“… 37 In Alberta, the utilization of cardiology services among Indigenous peoples was substantially lower compared to that of non-Indigenous peoples (0.28% vs 0.93% of the population; P < 0.01), despite their higher CVD burdens. 38 Between 1996 and 2015, an increase in the volume of percutaneous coronary interventions and coronary artery bypass grafting, as well as cardiovascular prescriptions, was observed among First Nations people in Ontario, with a notable reduction in cardiovascular events. 39 This finding holds promise that the gap is closing between the CVD burden and met cardiovascular care needs.…”

“…In Manitoba, Métis people were found to have higher prevalence rates of cardiovascular risk factors, such as diabetes, and CVD, such as ischemic heart disease, but disproportionately lower health care utilization and poorer outcomes compared to non-Métis People (37). In Alberta, the utilization of cardiology services among Indigenous Peoples was substantially lower compared to non-Indigenous people (0.28% vs. 0.93% of the population; p<0.01) despite higher CVD burdens (38). Between 1996 and 2015, an increase in the number J o u r n a l P r e -p r o o f 13 of percutaneous coronary interventions and coronary artery bypass grafting as well as cardiovascular prescriptions was observed among First Nations people in Ontario with a notable reduction in cardiovascular events (39).…”

Barriers to Peritoneal Dialysis in Aboriginal Patients

“…This disparity in Aboriginal health care use extends to renal transplantation 6 and also general health care utilization. 21 Our sample size and duration of follow-up were too limited to determine survival after dialysis initiation. However, other studies assessing associations of dialysis modality and mortality in Canadian Aboriginals have had conflicting results.…”

Key Challenges for Indigenous Peoples of Canada in terms of Oral Health Provision and Utilization: A Scoping Review

“…e approach is likewise supported by the Joanna Briggs Institute's approach for conducting scoping reviews [12]. us, the six stages included: (1) identifying the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarizing, and reporting the results, and (6) consultation with pertinent partners (optional) [11].…”

“…Oral health is important for good physical, mental, and psychological well-being [ 1 ]. Indigenous peoples have long been suffering from disparities in the Canadian healthcare system [ 2 ]. These disparities are even more evident in respect to the oral health of Indigenous peoples.…”