Access to health care among status Aboriginal people with chronic kidney disease.
BACKGROUND
Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease.


METHODS
We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists.


RESULTS
Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m(2)) were 43% less likely than non-Aboriginal people with severe chronic kidney disease to visit a nephrologist (hazard ratio 0.57, 95% CI 0.39-0.83). There was no difference in the likelihood of visiting a general internist (hazard ratio 1.00, 95% CI 0.83-1.21).


CONCLUSIONS
Increased rates of hospital admissions for ambulatory-care-sensitive conditions and a reduced likelihood of nephrology visits suggest potential inequities in care among status Aboriginal people with chronic kidney disease. The extent to which this may contribute to the higher rate of kidney failure in this population requires further exploration.
Gao
Song
S
Department of Medicine, Division of Nephrology, University of Calgary, Calgary, AB.
Manns
Braden J
BJ
Culleton
Bruce F
BF
Tonelli
Marcello
M
Quan
Hude
H
Crowshoe
Lynden
L
Ghali
William A
WA
Svenson
Lawrence W
LW
Ahmed
Sofia
S
Hemmelgarn
Brenda R
BR
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003697:Delphi Technique; D005260:Female; D005919:Glomerular Filtration Rate; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D009819:Office Visits / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D012042:Registries; D012720:Severity of Illness Index
D003404:Creatinine