title: Disparities in healthcare utilisation rates for Aboriginal and non-Aboriginal Albertan residents, 1997-2006: a population database study.
abstract: BACKGROUND
  It 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.
  
  
  METHODS
  Healthcare 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.
  
  
  RESULTS
  Healthcare 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].
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Chung
authors.forename: Ming
authors.initials: M
authors.lastname: Ye
authors.forename: Chris
authors.initials: C
authors.lastname: Hanson
authors.forename: Oluwaseun
authors.initials: O
authors.lastname: Oladokun
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Campbell
authors.forename: Gordon
authors.initials: G
authors.lastname: Kramer
authors.forename: Ordan J
authors.initials: OJ
authors.lastname: Lehmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D054625:Healthcare Disparities / Q000208:ethnology* / Q000266:history; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy; D008875:Middle Aged; D055815:Young Adult