Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada

Abstract

O ppression and racism are ongoing problems faced by Indigenous people, 1 a population that continues to have inequitable health outcomes compared with the Canadian general population. 2 Indigenous people often access health care when they are experiencing more severe or complex health care challenges. 3 Health care disparities among the Indigenous community is a problem previously studied; 4-7 however, little is known about access to care for inflammatory bowel disease (IBD) among Indigenous people. Inflammatory bowel disease, including Crohn disease and ulcerative colitis, is a chronic, idiopathic and incurable disorder, causing inflammation of the gastrointestinal tract. 8 Canada has one of the highest prevalence and incidence rates of IBD in the world. 9,10 In 2018, 0.7% of Canadians lived with IBD. 11 By 2030, researchers estimate that 1% of the Canadian population will have IBD. 11 Our research group (IBD Among Indigenous Peoples Research Team) reported that the prevalence of IBD among First Nations patients, the largest Indigenous subgroup in Canada, doubled between 1999 and 2016 (from 64 per 100 000 to 142 per 100 000 population) in Saskatchewan and estimated an annual average increase of 4.2%. 12 We also observed IBD annual incidence rates among First Nations patients, at around 11 per 100 000 inhabitants, and identified a predominance of ulcerative colitis relative to Crohn disease among First Nations patients. 12

Patient and Public Involvement in Inflammatory Bowel Disease Research—A Scoping Review

“…This retrospective cohort study involved indigenous patients in study outcome selection, data analysis, and the knowledge-sharing phases of research (wherein 1 advocate co-presented the published work at multiple conferences). 59 This was mediated by sending the engaged parties periodic reports and requesting regular feedback on results. 59 …”

“… 59 This was mediated by sending the engaged parties periodic reports and requesting regular feedback on results. 59 …”

The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

“…A study using health administrative data in Saskatchewan compared health services and medication utilization among First Nations individuals with IBD not living on reserves to the general IBD population ( 26 ). After adjusting for rural/urban residence, First Nations individuals with IBD in Saskatchewan were more likely than the general IBD population to be hospitalized for IBD-specific reasons (HR: 1.33; 95% CI: 1.01, 1.75).…”

“…There might be differences in biologic and immunomodulator therapy between First Nations individuals with IBD and people with IBD from the general population (biologic therapy unadjusted for rural/urban residence, HR: 0.58; 95% CI: 0.34, 0.99; biologic therapy adjusted for rural/urban residence, HR: 0.65; 95% CI: 0.38, 1.11; immunomodulator therapy adjusted for rural/urban residence, HR: 0.79; 95% CI: 0.55, 1.55) ( 26 ). First Nations individuals were less likely to be prescribed 5-ASA (HR: 0.56; 95% CI: 0.45, 0.71); this was consistent for Crohn’s disease and ulcerative colitis ( 26 ). Because of the relatively small numbers of First Nations individuals living with IBD, these estimates are imprecise and further studies within and across provinces are needed.…”

Storytelling of Indigenous patient and family advocates engaged in patient-oriented research initiatives in the field of inflammatory bowel disease

“… 5 Furthermore, the IBD-IPRT found that First Nations with IBD were less likely to claim IBD medications and had a higher risk of hospitalizations than the general population with IBD. 11 …”